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Motorcycle passenger’s burn of the right foot: prevention of a peculiar type of accident*

lchiro Kikuchi, Katsumi Ogata, lsao Taketomi, Yoko Aoki and Shohei lnoue

Department of Dermatology, Miyazaki Medical College, Kiyotake, Japan

Summary The right feet of two children, passengers on small motorcycles, were caught between the rear wheels and the exhaust boxes. leading to deen bums. This tvne of accident is on the increase in Japan. Treatment and prevention of such bums are discussed. We suggest that an improvement in the motorcycle will be a solution.

INTRODUCTION SMALL motorcycles, or bikes equipped with 50 cc engines, have become very popular in Japan. Although it is illegal to give another person a ride on the rear luggage carrier of small motorcycles, it is possible to do so on some types. A peculiar type of burn has occurred more frequently recently as a result of such unlawful acts. We report two cases, with con- sideration of the prevention of such accidents and the treatment of such burns.

CASE REPORTS Case 1 A 7-year-old Japanese girl was given a ride on the rear luggage carrier of a 50 cc motorcycle by her mother and her right foot was accidentally caught between the rear wheel and the exhaust box of the motorcycle. A carpenter passing by broke the exhaust box with an instrument and helped her out of the trouble. An ulcer resulted on the lateral aspect of the dorsum of the right

*On 13 September 1979, a new minibike made its debut from the manufacturer of the motorcycles. In reply to the authors’ demand the frame used prevented accidental insertion ofthe child’s foot between the rear wheel and the mutIler.

foot and the lower aspect of the right leg. ARer treat- ment at another clinic, she was admitted to the Department of Dermatology, Miyazaki Medical College. Fig. 1 shows her right foot at admission. A full-thickness skin grafting was successfully performed. It took 48 days for her wound to heal, including treat- ment at another clinic and admission at our Hospital.

Case 2 An 1 I-year-old Japanese boy was given a ride on the rear luggage carrier of a 50 cc bike (the type was exactly the same as in Case I) by a male adult, and the boy’s right foot was accidentally caught between the spokes of the rear wheel and the exhaust box. The bike was starting slowly and abruptly stopped. Because the bike belonged to someone else whom they didn’t know, they dissembled the silencer taking much time. During the period of extraction of the foot, they poured cold water onto the boy’s foot; they noticed that the boy’s sock was not burnt. The boy’s foot received third degree bums showing white discolour- ation. He visited us the next day, but he was transferred to another hospital because all beds had been occupied. A split-thickness skin grafting was performed on day 13 post burn, but the graft did not take. He was admitted to the Department of Dermatology, Miyazaki Medical College on day 25 post bum. The wound was very deep, and tendons of M. extensor digitorum longus were exposed and some of them degenerated during local treatment (Fig. 2). After the development of good granulation tissue, a full-thickness skin graft was transplanted from the abdomen on day 54. M. extensor hallucis brevis was cut during operation. The central part of the graft developed a linear necrosis which was removed under local anesthesia. It took over 90 days for his wound to heal, including treatment at another hospital. He again

Kikuchi et al.: Motorcycle passenger’s burn 273

Fig. 1. The rear passenger’s bum after treatment at another hospital. The site of involvement is typical and common in all cases.

Fig. 2. Granulation tissue and tendons of M. extensor digitorum longus showing the depth of injury.

Fig. 3 The final result of Case 2, after full-thickness skin grafting. Necrosis occurred partially.

became a fast runner at school, the fastest among a group of 7, while he had been the fastest among 40 classmates. Dorsiflexion of the right 5th toe was not possible. Fig. 3 shows the final result.

DISCUSSION Small motorcycles, or 50 cc bikes have become very popular in Japan. At the same time, a peculiar type of bum has also increased which is seen on the dorsum of the foot of the rear passenger. When we presented our cases at the fifth Annual Meeting of the Japan Society for Bum Injuries in 1979, Izawa stated that he had experienced 5 cases; 2 were so deeply injured that microsurgery was necessary. O’ya stated that he had treated 5 cases, and in a personal communication Nagasaki stated that he treated as many as 35 cases of bums due to the mufIler in a single year of 1978. The mechanism of the bum appears identical in all cases; the right foot being caught between the rear wheel and the mufIler. Previously, however, cases of burns due to the muftler have been seen when the motor- cycles fell on the feet. Nagasaki’s cases might include these cases.

One reason for writing this paper is that we believe that prevention of such burns is possible. First, it is advised not to give a person,

274 Burns Vol. ~/NO. 4

Fin. 4. The forearm ofan adult is intruded between the spokes and the exhaust box ofthe bike, showing the site ofaccident.

especially a young boy or a girl, a ride on the rear luggage carrier of a 50 cc motorcycle. In reality, under the Japanese traffic law, it is banned to give a person a ride on the rear luggage carrier (which appears to the pillion seat) of a 50 cc motorcycle. However, the situation is different with bigger bikes. The small feet of boys and girls could be easily caught between the wheel and the exhaust box of a peculiar type ofbike (Fig. 4).

Second, the motorcycle in question should be improved mechanically so that this kind of mishap should not happen. This is a problem to be solved by the manufacturer.

Third, we should be taught by the manufac- turer a quick and efficient method of extraction of the foot in case of accident. In treating Case 2, we concluded that the bike should have been sacrificed for the boy’s foot. Our opinions were conveyed to the manufacturer of the motorcycles.

The burn of the rear passenger is character- ized by the peculiar site of involvement; it

involves the lateral aspect of the dorsum of the right foot including the outer malleorus and extending into the lower leg. Within this area, a cross-leg flap is not indicated (Namba, 1972). The burns are sometimes very deep, and tendons and muscles may undergo degeneration. For the coverage of deep burns at this area, Ohtsuka et al. (1979) used microvascular techniques.

In both cases, we used full-thickness skin grafting. One disadvantage of this technique is that it takes a long period of time to prepare a good vascularized bed. The result of our Case 2 was not excellent cosmetically, but acceptable.

REFERENCES Namba K. (1972) Experiences with cross-leg flaps.

Jpn. J. Plast. Reconstr. Surg. 15, 123. Ohtsuka H., Shioya N., Hoshi, E. et al. (1979) A free

dorsalis pedis flap from the other foot combined with a dorsalis pedis pedicle flap from the same foot to close foot ulcers. Br. J. Plasf. Surg. 32,3.

Paper accepted 11 November 1979.

Requesfs for reprinls should be addressed to; Dr Ichiro Kikuchi, Department of Dermatology, Miyazaki Medical College, Kiyotake, Miyazaki, 889-16, Japan.