Christopher C. Richardson, DO, MS, FAAP, on Fractal Wood Burning Injuries

In this interview, Christopher C. Richardson, DO, MS, FAAP, medical director, Physician Network Medical Group, Adventist Health, Riverdale, California, discusses fractal wood burning injuries, their range of clinical presentation, and management approaches.

Can you describe fractal wood burning and what prompted your interest on this topic?

Fractal wood burning is the art of pyrography or burning wood to make art. Pyrography has been around for centuries, but fractal wood burning has become more popularized in the last several years on social media. Thousands of online videos demonstrate a step-by-step approach on how to create this very unique and stunning artwork by attaching electrical wire to either side of a transformer that has been extracted from a home microwave. The electrical wires are then attached to a wooden canvas that is coated in a conductive solution such as baking soda. From there, tree-like figures called Lichtenberg figures are burned into the wood. These high voltage transformers carry an enormous current that is lethal. I was struck by the unfamiliarity of the practice of fractal wood burning and how severe patients' injuries were as a consequence of this mechanism of high-voltage injury. I also recognized there was very little public information available discussing the preventable injuries related to this practice.

What are the range of injuries associated with this practice?

Injuries associated with fractal wood burning range from minor superficial burns to death. In most reports of fractal wood burning accidents, patients are found dead in their home with severe burns after suspected electrocution. One proposed mechanism of why the mortality rate appears to be extremely high is because artists handle the transformer with both hands. This creates horizontal current across the torso which may lead to immediate cardiac arrest from ventricular arrhythmias. Those fortunate enough to survive present with a range of burns and associated injuries related to high-voltage electrocution. Most burns associated with fractal wood burning accidents are located on the hands. However, there have been several news reports of victims tripping over the device (placed on the floor) and suffering more extensive burns to the back and torso. Third- and fourth-degree burns have been reported, resulting in permanent disfigurement and subsequent amputations.

What are some of the management approaches for these patients?

Patients that present with fractal burning related injuries should be managed similarly to those who have suffered high-voltage electrocution and associated burns. Given that many of the surviving victims present with third- and fourth-degree burns, as well as burns involving the hands, these patients would benefit from transfer to a burn center. Those who do not present in cardiac arrest should be observed closely on a cardiac monitor and examined thoroughly for other injuries.

What key messages would you like to leave your colleagues on this topic?

Given the apparent dangers of this practice, more published cases are needed in order to obtain a more accurate representation of the true incidence of fractal wood burning-related injuries, the associated mortality, and propensity for fatal cardiac arrhythmias, as well as further delineation of the variety of injuries possible. Escalated efforts should be made within the public health sector to warn the public of the dangers of fractal burning, and clinicians should be alerted to its significant popularity despite alarming morbidity and mortality.