1
|
Khor D, AlQasas T, Galet C, Barrash J, Granchi T, Bertellotti R, Wibbenmeyer L. Electrical injuries and outcomes: A retrospective review. Burns 2023; 49:1739-1744. [PMID: 37005139 DOI: 10.1016/j.burns.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
Electrical burns (EI) differ from other burn injuries in the immediate treatment given and delayed sequelae they manifest. This paper reviews our burn center's experience with electrical injuries. All patients with electrical injuries admitted from January 2002 to August 2019 were included. Demographics; admission, injury, and treatment data; complications, including infection, graft loss, and neurologic injury; pertinent imaging, neurology consultation, neuropsychiatric testing; and mortality were collected. Subjects were divided into those who were exposed to high (>1000 volts), low (<1000 volts), and unknown voltage. The groups were compared. P < 0.05 was considered significant. One hundred sixty-two patients with electrical injuries were included. Fifty-five suffered low voltage, 55 high voltage, and 52 unknown voltage injuries. High voltage injuries were more likely to be male (98.2% vs. 83.6% low voltage vs. 94.2% unknown voltage, p = 0.015), to experience loss of consciousness (69.1% vs. 23.6% vs. 33.3%, p < 0.001), cardiac arrest (20% vs. 3.6% vs. 13.4%, p = 0.032), and undergo amputation (23.6% vs. 5.5% vs. 8.2%, p = 0.024). No significant differences were observed in long-term neurological deficits. Twenty-seven patients (16.7%) were found to have neurological deficits on or after admission; 48.2% recovered, 33.3% persisted, 7.4% died, and 11.1% did not follow-up with our burn center. Electrical injuries are associated with protean sequelae. Immediate complications include cardiac, renal, and deep burns. Neurologic complications, while uncommon, can occur immediately or are delayed.
Collapse
Affiliation(s)
- Desmond Khor
- Department of Surgery, Acute Care Surgery Division, USA
| | - Tareq AlQasas
- Department of Surgery, Acute Care Surgery Division, USA
| | - Colette Galet
- Department of Surgery, Acute Care Surgery Division, USA.
| | - Joseph Barrash
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | | | | |
Collapse
|
2
|
Kadiri IA, Ogundipe KO, Yusuf MB. Chronic osteomyelitis of the right femur after electrical burn: A case report. Int J Surg Case Rep 2023; 109:108526. [PMID: 37481976 PMCID: PMC10369462 DOI: 10.1016/j.ijscr.2023.108526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Osteomyelitis is a bone infection that can occur as a rare late complication of electrical burns. It may occur in any bony part of the body where there has been an electrical burn injury. Osteomyelitis occurs several weeks or months after the initial infection, and can persist for several months or years, and is difficult to manage. To our knowledge, to date, no chronic osteomyelitis of the femur has been reported after an electrical burn injury. CASE PRESENTATION The present case report is of a 40-year-old man who sustained a high voltage electrical burn injury involving his right upper and lower limbs as well as the posterior trunk. The estimated total body surface area burned was 20 %. He developed chronic osteomyelitis of the right femur several months after the initial injury. CLINICAL DISCUSSION The upper extremities are the sites most frequently affected by chronic osteomyelitis following electrical burns. Staphylococcus aureus is the most common causative organism, and treatment entails a combined medical and surgical approach. CONCLUSION Osteomyelitis of the long bones of the lower extremities is an uncommon complication of electrical burn injuries involving the lower limbs. We, however, advocate a high index of suspicion when faced with electrical burns of the lower extremity.
Collapse
Affiliation(s)
- Innih Asuekome Kadiri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria; Department of Surgery, Faculty of Clinical Sciences, Ekiti State University, Ado Ekiti, Nigeria.
| | - Kolawole Olubunmi Ogundipe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria; Department of Surgery, Faculty of Clinical Sciences, Ekiti State University, Ado Ekiti, Nigeria.
| | - Moruf Babatunde Yusuf
- Division of Orthopaedics and Traumatology, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria; Department of Surgery, Faculty of Clinical Sciences, Ekiti State University, Ado Ekiti, Nigeria.
| |
Collapse
|
3
|
Zhang MM, Radulovich NP, Fu R, Eagle RC, Stefanyszyn MA. Electrical burn of the eye and orbit with severe delayed sequelae from an arc welding accident. Orbit 2023:1-4. [PMID: 37276340 DOI: 10.1080/01676830.2023.2220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
A 28-year-old male presented to the emergency room suffering an ocular burn injury from a welding rod. Given the mechanism of injury, severe delayed injury of the ocular adnexa occurred, requiring enucleation, partial exenteration of the superior orbit, and extensive reconstruction. Histopathology of the affected tissue was analyzed. This is the first report that details the clinical course of a patient with delayed high amperage and low voltage electrical burn injury.
Collapse
Affiliation(s)
- Matthew M Zhang
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicholas P Radulovich
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburg, Pittsburgh, Pennsylvania, USA
| | - Ralph C Eagle
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary A Stefanyszyn
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Pedrazzi N, Klein H, Gentzsch T, Kim BS, Waldner M, Giovanoli P, Plock J, Schweizer R. Predictors for limb amputation and reconstructive management in electrical injuries. Burns 2022:S0305-4179(22)00208-X. [PMID: 36031494 DOI: 10.1016/j.burns.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electrical injuries follow a specific pathophysiology and may progressively damage both skin and deeper tissues, frequently ending in amputations. Type and timing of soft tissue reconstruction after electrical burns is crucial for proper outcome. The aim of this study was to assess surgical management and outcome of patients with electrical injuries treated at the Zurich Burn Center over the last 15 years, with emphasis on risk factors for amputation and reconstructive strategy. METHODS Patient charts were reviewed retrospectively to identify cases admitted at the Zurich Burns Center (2005-2019). Patient characteristics and surgical management, with a special focus on amputations, reconstruction and outcome were analyzed and risk factors for amputation were assessed. RESULTS Eighty-nine patients were identified and a total of 522 operations were performed. Escharotomy and fasciotomies were performed in 40.5% and 24.7% of cases, respectively, mainly at admission. The total amputation rate was 13.5% (23 amputations, 12 patients). Development of compartment syndrome, rhabdomyolysis, high myoglobin and CK blood levels, kidney failure, sepsis and respiratory complications during the course were related to higher risk of amputation (p < 0.001). Sixty-six flap-based reconstructions were performed (25% cases): 49 loco-regional flaps, 3 distant pedicled flaps, 14 free flaps. Two flaps were lost (flap failure rate 14%). Both flap losses occurred in cases of early reconstruction (within 5-21 days). CONCLUSIONS Electrical injuries are still cause of elevated morbidity and mortality, with high amputation rate. Predictors for amputation can support physicians in the surgical care and decision-making. Reconstruction remains challenging in this type of injury: the surgical management with early decompression, serial necrectomies and delayed early reconstruction remains the procedure of choice at our unit.
Collapse
|
5
|
Basuki A, Song A, Yovita NV, Suryadinata KL, Sagala AE. The treatment challenges and limitation in high-voltage pediatric electrical burn at rural area: A case report. Int J Surg Case Rep 2021; 82:105857. [PMID: 33839630 DOI: 10.1016/j.ijscr.2021.105857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Although rare, electrical injury in pediatrics is potentially life threatening and has significant and long-term impact in life. It is challenging to manage such cases in rural areas. PRESENTATION OF CASE A fully conscious 13-year-old boy was admitted to the emergency room after being electrocuted by high-voltage power cable, with superficial partial thickness burn over right arm, trunk, and left leg (26 % of total body surface area). Tachycardia and non-specific ST depression was found on ECG examination and was diagnosed with high-voltage electrical injury. Treatments were based on ANZBA algorithm with several modifications, i.e., administering lower concentration of oxygen with nasal cannula instead of non-rebreathing mask as well as Ketorolac and Antrain® for analgesic instead of morphine. DISCUSSION Different choices of treatments were given due to limited resources. Despite possible cardiac and renal complication, further tests could not be done. Fortunately, after strict monitoring, no signs of abnormality were found. We used silver sulfadiazine, Sofratulle® and dry sterile gauze as a dressing of choice following immediate surgical debridement. The patient was observed daily through 7 days of hospitalization and followed-up for 1 year, achieving normal physiologic function of the affected area but unsatisfactory esthetic result. CONCLUSION Lack of infrastructure, drugs, and trained personnel are some of the challenges that still exist in most rural areas. Thus, implementation of available standardized guidelines such as ANZBA, and giving similar training to personnel as well as providing feasible equipment followed by strict monitoring for the patient are needed to achieve maximum results.
Collapse
|
6
|
Macías-Hernández SI, Zepeda-Mora R, Torres-Mondragón L, Morales GM, Tolentino-Bazan K, Morales-García M, Suástegui-Nava G, Nava-Bringas TI, Morones-Alba JD. Bone mineral density and low bone mass in severely burned patients: A retrospective cohort study. Bone 2021; 143:115782. [PMID: 33278654 DOI: 10.1016/j.bone.2020.115782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Severe burns can alter bone metabolism through different mechanisms. Despite prior published studies describing the association between burns and a decrease in bone mineral density (BMD), no clinical guidelines currently exist recommending the systematic evaluation of bone health in patients after severe burns. This study aims to describe the BMD of individuals with severe burn injuries and healthy controls and determine the frequency of low-to-normal bone mass (LNBM) and BMD below the expected range for age (BEA). MATERIALS AND METHODS We conducted a retrospective cohort of patients with either severe thermal or electrical burns and healthy controls paired by gender and age. We performed a dual-energy X-ray absorptiometry at least 90 days after the burn and collected data from each patient's clinical evaluation and clinical file. RESULTS A total of 77 patients (64 men and 13 women) and their paired controls were included in the study (age [mean ± standard deviation, SD]: 30.37 ± 8.66 years). Patients participated in the study an average of 315 ± 438 days after their burn. The BMD (grs/cm2) in total hip burned vs controls was: 0.998 ± 0.135 vs 1.059 ± 0.12 (p = 0.004); femoral neck 0.876 ± 0.121 vs 0.915 ± 0.097 (p = 0.031), spine 0.977 ± 0.127 vs 1.003 ± 0.076 (p = 0.132).The Z-scores for total hip were - 0.06 ± 1.05 vs 0.41 ± 0.80 (p = 0.002); for neck -0.39 ± 0.89 vs -0.01 ± 0.77 (p = 0.005); and for spine -0.75 ± 1.11 vs -0.32 ± 0.73 (p = 0.005). The proportion of subjects with BMD BEA in burns vs controls was 5.2 vs 1.2% (p = 0.05) in total hip, 3.9 vs 0% (p = 0.045) in the neck, and 18.2 vs 1.2% (p = 0.001) in the spine. The logistic regression model found-in burn patients vs controls-an OR of 9.83 for BMD BEA (CI 95%: 2.17-44.45, p = 003), OR = 4.05 for electrical burns (CI 95%: 1.72-20.89, p = 004) and OR = 15.16 for thermal burns (CI 95%: 2.91-79.00, p = 001). The model also found an OR = 2.48 for LNBM (CI 95%: 1.25-4.93, p = 0.009). The burn variables associated with BMD BEA at any site in the patients were BMI >25 Kg/m2 with an OR = 0.180 (CI 95%: 0.046-0.710, p = 0.014); and the lower limb amputation with an OR = 7.33 (CI 95%; 1.12-48.33, p = 0.038). Five burn patients had a fragility fracture. CONCLUSION BMD was significantly lower in severely burned patients than in controls, and the proportion BMD BEA cases was significantly higher in the burn patient sample. Severe burns are a strong independent predictor of bone loss, and this risk is maintained for an extended period after the burn.
Collapse
Affiliation(s)
- Salvador Israel Macías-Hernández
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
| | - Rafael Zepeda-Mora
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Laura Torres-Mondragón
- Postgraduate Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Gerardo Martínez Morales
- Postgraduate Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | - Gabriela Suástegui-Nava
- Osteoporosis Clinic, Densitometry Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Tania Inés Nava-Bringas
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Juan Daniel Morones-Alba
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| |
Collapse
|
7
|
Miguel-Sardaneta ML, Martínez-Tovilla Y, Solís-Cordero FD, Saavedra-Pacheco MS, Gil-Vargas M. Creatine phosphokinase MB levels as a diagnostic marker of myocardial dysfunction in pediatric patients with electrical burns. Bol Med Hosp Infant Mex 2020; 77:320-326. [PMID: 33186345 DOI: 10.24875/bmhim.20000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = -0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions The cardiac ultrasound influences decision making to improve the prognosis of these patients.
Collapse
Affiliation(s)
- Mariana L Miguel-Sardaneta
- Servicio de Pediatría, Hospital General Zona Norte de Puebla, Servicios de Salud del Estado de Puebla; Puebla, México
| | - Yaneth Martínez-Tovilla
- Unidad Pediátrica de Quemados (Anexo a Hospital del Niño Poblano), Servicios de Salud del Estado de Puebla; Puebla, México
| | - Fernando D Solís-Cordero
- Servicio de Cirugía Pediátrica, Hospital General de Puebla Eduardo Vázquez Navarro, Servicios de Salud del Estado de Puebla; Puebla, México
| | | | - Manuel Gil-Vargas
- Servicio de Cirugía Pediátrica, Hospital General de Puebla Eduardo Vázquez Navarro, Servicios de Salud del Estado de Puebla; Puebla, México
| |
Collapse
|
8
|
Joshi R, Krishna D, Khan MM. Use of Dorsal Ulnar Artery Flap for Coverage of Arterio-Cutaneous Fistula over Post- Electrical Burn Scar: A Case Report. World J Plast Surg 2020; 9:232-234. [PMID: 32934938 PMCID: PMC7482533 DOI: 10.29252/wjps.9.2.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We reported a 38 year old male patient who suffered from electric burn 2 years ago, and came with complaints of recurrent profuse bleeding from post electric burn scar over left wrist area since last 6-8 months. We successfully used the dorsal ulnar artery flap to cover the arterio-cutaneous fistula over the post-electrical burn scar.
Collapse
Affiliation(s)
- Rishabh Joshi
- Department of Burns and Plastic Surgery, AIIMS, Bhopal (M.P.), India
| | - Deepak Krishna
- Department of Burns and Plastic Surgery, AIIMS, Bhopal (M.P.), India
| | - Manal M Khan
- Department of Burns and Plastic Surgery, AIIMS, Bhopal (M.P.), India
| |
Collapse
|
9
|
Roshanzamir S, Keshavarzi E. Sympathetic skin response impairment: A good predictor of bone loss in electrical burn victims. Burns 2020; 46:394-9. [PMID: 31848086 DOI: 10.1016/j.burns.2019.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/18/2019] [Accepted: 07/23/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Burn victims are reported to have more possibility of bone loss in acute phase of injury partly due to sympathetic dysfunction and catecholamine increase beside other hypermetabolic responses. These patients are also prone to autonomic neuropathy and sympathetic skin response (SSR) impairment. We aim to investigate the correlation between SSR in the acute phase and bone mineral density (BMD) parameters in electrical burn patients and determine whether the SSR parameter in initial weeks of the event is a good predictor of bone loss in long term. MATERIALS AND METHODS Sixty two individuals exposed to low voltage(<1000 V) electrical current were invited to a cohort study. The SSR was recorded from their four limbs in 2-5 weeks after injury. Then, dual X-ray absorptiometry (DXA) was done to measure their BMD, T-score and Z -score, 9-12 months later. The correlation between SSR parameters in acute phase and DXA indexes was evaluated using Spearman test. A Roc curve was charted to point out a cut-off value for SSR amplitude and latency in respect to T-score to predict the subsequent bone loss. RESULT All the patients were male with a mean age of 34.09 years. Biphasic SSR parameters showed a significant correlation with lumbar BMD in a confidence interval of 99.9%. SSR amplitude threshold of 293.75 μV and latency of 2.15 s had a 100% sensitivity and 94% and 83% specificity respectively for predicting the bone loss (T-score<-1) in long term. The area under Roc curve was 0.94 and 0.99 in terms of SSR amplitude and latency. CONCLUSION SSR recorded in the first few weeks after electrical injury is a good predictor of bone loss in long term, so we recommend this test as a guide for screening the patients at risk for osteoporosis in electrical burn and formulating the preventive measurements.
Collapse
|
10
|
Tolouie M, Farzan R. A Six-Year Study on Epidemiology of Electrical Burns in Northern Iran: Is It Time to Pay Attention? World J Plast Surg 2019; 8:365-371. [PMID: 31620340 PMCID: PMC6790258 DOI: 10.29252/wjps.8.3.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although electrical burns are less prevalent than other types, they put socioeconomic burden on communities, yielding higher mortalities. Therefore, the frequency and causes of electrical burns in the largest burn center in northern Iran were studied. METHODS All patients with electrical burn injuries admitted to Velayat Hospital, Rasht, Iran participated in this descriptive cross-sectional study. The data collection tool was a checklist including demographic data, damage mechanism, voltage classification (high or low), injured organ, ICU need, length of stay (LOC), electrical burn severity (degree and area of burns based on TBSA), surgical interventions, and return to work. All data were gathered through HIS system and analyzed. RESULTS Most electrical burns occurred in men (99.4%) and most of whom had electricity-related jobs (26%). The majority of victims had third-degree burns (63%), and electrical current-induced burns in entry points occurred in the upper and lower extremities, head and other organs ranked the first to fourth, respectively. Most burns happened due to abrupt contact with electrical current (83.33%) in routine home activities (52.78%). The mean LOC was 8.73 days, suggesting that LOC increased significantly, if the electrical current entered the body through lower extremities, while it decreased significantly, if the electrical current exited through lower extremities. CONCLUSION The majority of electrical burn victims were men. Most burns occurred in urban communities in summer. Most people were affected by high voltage electricity.
Collapse
Affiliation(s)
- Mohammad Tolouie
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ramyar Farzan
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
11
|
Moon P, Jithendran N. Invasive Fungal Infection with Absidia Corymbifera in Immunocompetent Patient with Electrical Scalp Burn. World J Plast Surg 2018; 7:249-252. [PMID: 30083512 PMCID: PMC6066699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Invasive fungal infection in burn injury is caused by inoculation of fungal spore from patient skin, respiratory tract or from care giver. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonization, hyperglycemic episodes and other immunosuppressive disorders. Invasive fungal infection with Absidia corymbifera is rare opportunistic infection encountered in patient with burn injury. The key for treatment is early clinical diagnosis, wide and repeated debridement and systemic and local antifungal treatment. We describe a case of invasive fungal infection with A. corymbifera in a patient with post-electrical scalp burn with late presentation after 10 days of injury in an immunocompetent patient.
Collapse
Affiliation(s)
- Prashant Moon
- Krishna Hospital and Research Center, Gurunanak Pura, Nainital Road, India,Corresponding Author: Prashant Moon, MD, Krishna Hospital and Research Center, Gurunanak Pura, Nainital Road, Heydarabad, India. E-mail:
| | | |
Collapse
|
12
|
Jang YS, Lee BH, Park HS. Lower amputation rate after fasciotomy by straight midline incision technique for a 22,900-V electrical injury to the upper extremities. Injury 2017; 48:2590-2596. [PMID: 28969851 DOI: 10.1016/j.injury.2017.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to compare the major amputation rate following two different fasciotomy techniques, conventional versus straight midline, in patients with high-voltage arc burn injury by electric currents of 22,900V to the upper extremities. METHODS A retrospective analysis of 230 patients (270 burned upper limbs) who underwent fasciotomy after high-voltage electrical injuries between 1996 and 2007 was performed. The patients were divided into two groups according to the fasciotomy method used. From 1996 to 2002, 158 patients (184 limbs) underwent conventional fasciotomy by Green's volar-ulnar incision (conventional fasciotomy group). From 2003 to 2007, 72 patients (86 limbs) underwent fasciotomy using a straight midline curved incision (midline fasciotomy group). The patients were also divided into two groups based on whether the fasciotomy procedure was performed early or late. Patients who underwent fasciotomies <8h after injury were classified as early, while those who underwent it >8h after injury were classified as late. Major amputation rates were compared between two fasciotomy methods and analyzed following fasciotomy timing. RESULTS The midline fasciotomy group had a significantly lower major amputation rate (33.7%) than the conventional fasciotomy group (59.2%) (p<0.001). A subsequently decreased major amputation rate of 27.8% was observed in the early fasciotomy subgroup of the midline fasciotomy group (p=0.025). CONCLUSION Early fasciotomy remarkably reduced the major amputation rate after high-voltage arc injury; in the setting of minimized vascular exposure after fasciotomy, a midline straight incision could ensure that various types of reconstructive microsurgical procedures and primary skin closures can be used to save limbs.
Collapse
Affiliation(s)
- Young-Soo Jang
- Department of Orthopaedic Surgery, Seonam Hospital, Seoul, Korea.
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
| | - Hyun-Soo Park
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea.
| |
Collapse
|
13
|
Basu SK, Bain J, Majumdar BK, Chattopadhyay D, Baitalik D, Dewangan YK, Bhattacharya D, Rakshit P, Gupta V, Kumar A, Haldar RN. From wheelchair to walking: First case report of post- electrical burn destruction of patellar ligament with its one-stage reconstruction and restoration of function. Indian J Plast Surg 2017; 50:100-103. [PMID: 28615820 PMCID: PMC5469217 DOI: 10.4103/ijps.ijps_200_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Electrical burn injury causing bilateral patellar ligament destruction leading to complete loss of knee extension is a very rare injury. In such situation, surgical repair or reconstruction of the patellar ligament becomes necessary to restore knee functions. Here, we present such a case of an 8-year-old boy, whose both patellar ligaments were destroyed throughout its length due to high-voltage electrical injury. His left knee joint cavity was exposed and grossly infected, but the right knee joint cavity was apparently intact. The right-sided patellar ligament was reconstructed with an ipsilateral and looped semitendinosus tendon graft and covered with a medial gastrocnemius musculocutaneous flap. The patient had an uneventful recovery, and full range of motion in the right knee joint along with good bipedal locomotion was achieved successfully.
Collapse
Affiliation(s)
- Sandip Kanti Basu
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Jayanta Bain
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bijay Kumar Majumdar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Debarati Chattopadhyay
- Department Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debasis Baitalik
- Department of Plastic Surgery, M.R. Bangur Hospital, Kolkata, West Bengal, India
| | | | | | - Pritha Rakshit
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Vivek Gupta
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Ashwani Kumar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rathindra Nath Haldar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| |
Collapse
|
14
|
Abstract
Upper extremity electrical injuries present with unique pathophysiologic considerations due to the differing mechanisms of injury produced by the electromagnetic field. The initial phase of treatment consists of recognition of other life-threatening injuries, stabilization of patients, and multisystem resuscitation. The second phase of treatment consists of excising devitalized tissue, appropriate wound care to prevent delayed infection, providing temporary and definitive coverage over vital structures, and preventing contracture and joint stiffness via aggressive therapy. The final phase of treatment consists of sensorimotor functional reconstruction via nerve grafting and tendon transfers available based on patients' deficits and available redundant sources.
Collapse
Affiliation(s)
- Ketan Sharma
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St Louis, MO 63110, USA
| | - Miles Bichanich
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St Louis, MO 63110, USA
| | - Amy M Moore
- Hand Fellowship, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St Louis, MO 63110, USA.
| |
Collapse
|
15
|
Roshanzamir S, Dabbaghmanesh MH, Dabbaghmanesh A, Nejati S. Autonomic dysfunction and osteoporosis after electrical burn. Burns 2016; 42:583-8. [PMID: 26916589 DOI: 10.1016/j.burns.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 09/04/2015] [Accepted: 09/11/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several studies have shown the importance of the sympathetic nervous system in bone metabolism. There is an evidence of sympathetic skin response (SSR) impairment in electrical burn patients up to 2 years after their injuries. The acute phase of burn is accompanied by increased bone resorption. Whether the prolonged dysfunction of sympathetic nervous system may result in bone metabolism derangement even after the acute phase of electrical burn is the inspiring question for this study. And we tried to find correlation between SSR abnormality and areal bone mineral density (BMD) in electrical burn patients 6 months or more after the incidents. METHODS AND MATERIALS 42 electrical burn patients (≥6 months prior to study) who did not have a known joint or bone disease, history of neuropathy (central or peripheral), diabetes mellitus or consumption of any drug affecting the autonomic nervous system or evidence of neuropathy in nerve conduction study were recruited. We also gathered a control group of 50 healthy subjects (without electrical burn or the exclusion criteria). They went under dual energy X-ray absorptiometry and SSR study. Data were analyzed statistically with SPSS 16.0 making use of independent t-test and Pearson correlation coefficient. P<0.05 was considered significant statistically. RESULTS Areal BMD was significantly lower in electrical burn patients than control group (P<0.001). SSR latency was significantly prolonged and its amplitude was significantly reduced in burn patients compared to control group (P<0.001). In burn patients there was an inverse correlation of areal BMD of lumbar vertebrae, left femur neck and total femur with SSR latency and a direct correlation of areal BMD with SSR amplitude. In control group there was just direct correlation of areal BMD of lumbar vertebrae and left femur neck with SSR amplitude. CONCLUSION Electrical burn patients are at risk of reduced areal BMD long after their injuries. Sympathetic derangement and impaired SSR are correlated with reduction in areal BMD in these patients.
Collapse
Affiliation(s)
- Sharareh Roshanzamir
- Shiraz Burn Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Dabbaghmanesh
- Shiraz Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Solmaz Nejati
- Department of Physical Medicine and Rehabilitation, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
16
|
Zhao JC, Xian CJ, Yu JA, Shi K. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn. Int Wound J 2015; 12:59-62. [PMID: 23490336 PMCID: PMC7950919 DOI: 10.1111/iwj.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/28/2013] [Indexed: 12/01/2022] Open
Abstract
Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.
Collapse
Affiliation(s)
- Jing-Chun Zhao
- Burns and Plastic Reconstruction Unit, the First Hospital of Jilin University, Changchun, China
| | | | | | | |
Collapse
|
17
|
Abada H, Aktouf A, Delaunay F, Lievain L, Auquit-Auckbur I. [Alopecia reconstruction by expansion after a scalp burn injury caused by Taser(®): a case report]. Ann Dermatol Venereol 2014; 141:769-72. [PMID: 25433929 DOI: 10.1016/j.annder.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/22/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scarring alopecia resulting from burns may be difficult to treat and involves various plastic surgery techniques such as expanded scalp flaps. OBSERVATION Herein, we report the case of a 19-year-old male patient who suffered burning of the scalp with scarring alopecia following an attack with a Taser(®) electrical gun. Given the extent and site of alopecia, we decided to create a prosthesis by means of scalp expansion. The cosmetic result was satisfactory. DISCUSSION Several scalp reconstruction techniques have been described for scarring alopecia, with the most widely used being expansion, scalp flaps, repeated excision and hair implants. CONCLUSION The present case suggests that scalp expansion offers an effective method for the reconstruction of scarring alopecia following burns with a Taser(®) device.
Collapse
Affiliation(s)
- H Abada
- Service de chirurgie plastique, reconstructrice et esthétique - SOS mains, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - A Aktouf
- Service de chirurgie plastique, reconstructrice et esthétique - SOS mains, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - F Delaunay
- Service de chirurgie plastique, reconstructrice et esthétique - SOS mains, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - L Lievain
- Service de chirurgie plastique, reconstructrice et esthétique - SOS mains, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - I Auquit-Auckbur
- Service de chirurgie plastique, reconstructrice et esthétique - SOS mains, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| |
Collapse
|
18
|
Marques EG, Júnior GAP, Neto BFM, Freitas RA, Yaegashi LB, Almeida CEF, Júnior JAF. Visceral injury in electrical shock trauma: proposed guideline for the management of abdominal electrocution and literature review. Int J Burns Trauma 2014; 4:1-6. [PMID: 24624308 PMCID: PMC3945822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/30/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Victims of electrical burns account for approximately 5% of admissions to major burn centers. The first case of visceral injury caused by electrical burns was described in 1927 by Simonin, who reported perforation of the small intestine. Other rare cases were reported over the following years. The colon and small intestine were the organs most frequently affected. Less frequently involved organs were the heart, esophagus, stomach, pancreas, liver, gallbladder, lung, and kidney. We highlight the potential fatal visceral injuries after the electrical trauma. This study provides a review on this topic and proposes a management flowchart that should be adopted by the multidisciplinary team to treat these patients. CONCLUSION Visceral injuries are rare in electrical burns victims, but it can be severe and are associated with high rates of morbidity and mortality, sometimes requiring a more interventional approach.
Collapse
Affiliation(s)
- Evelyne Gsc Marques
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Gerson A Pereira Júnior
- Emergency Surgery and Trauma, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Bruno F Muller Neto
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Rodrigo A Freitas
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Lygia B Yaegashi
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Carlos E Fagotti Almeida
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo Brazil
| | - Jayme Adriano Farina Júnior
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo Brazil
| |
Collapse
|
19
|
Bae EJ, Hong IH, Park SP, Kim HK, Lee KW, Han JR. Overview of ocular complications in patients with electrical burns: an analysis of 102 cases across a 7-year period. Burns 2013; 39:1380-5. [PMID: 23688678 DOI: 10.1016/j.burns.2013.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/02/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ocular complications from electrical burns are uncommon. Thus far, there has been no systematic review on ocular electrical trauma with emphasis on patients' ophthalmic complications and visual symptoms. Herein, we retrospectively analyzed records of patients with electrical injuries to summarize the ophthalmic characteristics and explore their relationships with visual symptoms. METHODS We collected the medical records of 102 patients who consulted from 557 electrical burn patients between 2004 and 2010. Ophthalmic, systemic and demographic factors associated with electrical burns were identified in the patient who underwent the ophthalmic consultations. Two sets of comparisons were used to determine the demographic and systemic factors that were related to ophthalmic complications and the subjective outcome of visual impairment. RESULTS There were 53 eyes (29 patients) with ophthalmic complication were identified. Corneal epithelial erosion was the most common ocular electrical injury and the primary reason for subjective visual symptoms. Electrical burns affecting the head and neck were significantly related to subjective symptoms of visual disturbances. CONCLUSION Present study indicates that earlier involvement of ophthalmologists in the case of any patient who has suffered a facial burn is advisable. Appropriate management would be helpful to prevent future complications and alleviate visual symptoms.
Collapse
Affiliation(s)
- Eun Jin Bae
- Department of Ophthalmology, College of Medicine, Hallym University, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
20
|
Thomson CJ, Miles DA, Beveridge J, Chang PS. Treatment of electrical burns by single debridement followed by free-flap coverage: How important is timing? Can J Plast Surg 2004; 12:35-6. [PMID: 24115871 DOI: 10.1177/229255030401200109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND High-voltage electrical burns involving the extremities may cause marked loss of skin and subcutaneous tissue exposing underlying bone and tendon. Treatment of electrical burns has historically involved serial debridement with late wound closure. Success has been reported with the use of microvascular free-flap transfer within three days of injury. OBJECTIVE Seven patients with severe high-voltage electrical burns are presented. The application and timing of microvascular free-flap coverage is discussed. RESULTS Six of the seven patients achieved successful healing with the free flaps. CONCLUSION Delay of microvascular free-flap coverage beyond the previously published three-day protocol may not dramatically affect treatment success.
Collapse
|
21
|
Piplani S, Sethi GS. MYOCARDIAL INJURY IN ELECTRICAL BURNS. Med J Armed Forces India 2001; 57:251-3. [PMID: 27365611 DOI: 10.1016/s0377-1237(01)80059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- S Piplani
- Classified Specialist (Medicine), 5 Air Force Hospital, C/o 99 APO
| | - G S Sethi
- Classified Specialist (Surgery), Command Hospital (Air Force), Bangalore 560 007
| |
Collapse
|