Subcutaneous Gas From Hydrogen Peroxide Administration Under Pressure

Sir .—Hydrogen peroxide is an irrigant widely used for the cleansing of dirty wounds. Subcutaneous gas caused by the liberation of oxygen from hydrogen peroxide when it is used as an irrigant under pressure is an unusual but potentially serious complication (see also Oberg and Lindsey 1 ) that could be mistaken for an infection secondary to a gas-forming organism. We report two cases to warn physicians that subcutaneous gas can occur if hydrogen peroxide under pressure is used to cleanse wounds. Patient Reports .—Patient1.—A 3-year-old boy was brought to the hospital pediatric emergency room because of a three-day history of a swollen, tender right arm from a brush burn on concrete. Initial examination by the emergency room physician revealed a 13X15-cm, erythematous, indurated, and swollen area with questionable fluctuance approximately 3.5 cm below the right lateral epicondyle. Incision and drainage produced a minimum of serosanguinous fluid (no frank pus),