Electrical Burn Injury Research Articles

A new, simple technique for gradual primary closure of fasciotomy wounds.

The aim of this study was to demonstrate a new, easy and safe technique, which has not been defined in the literature previously, that enables the gradual primary closure of fasciotomy wounds using barbed sutures. The technique was performed on five patients who presented with fasciotomy wounds on both upper and lower extremities, varying in size, observed after compartment syndrome due to different causes. The average width of the defects for which primary closure was planned was 8.8 cm. Following the fasciotomy incision, absorbable barbed sutures were inserted through the dermal tissue around the wound similar to that of a subcuticular closure, but left loose, after which closed dressing was applied. During the clinical follow-up, with the decrease in tissue edema and tightness around the wound, the barbed suture was tightened at bedside every 48-72 hours. At the end of this gradual closure, all the fasciotomy defects were primarily closed within an average of 8.6 days. All the patients had complete and uncomplicated primary closure with the exception of one with high-voltage electrical burn injury, who developed necrosis in the distal part of the defect, and was treated by secondary healing. The gradual fasciotomy closure technique with barbed suture seems to be an easy, rapid and effective method.

Prognostic factors in electrical burns: A review of 101 patients

PurposeElectrical burn wounds are among the most devastating of burns, with wide-ranging injuries. We aimed to document the factors affecting the mortality rate of patients presenting with electrical burn wounds to our regional burn centre. MethodsThis retrospective study was conducted on 101 patients from January 2009 to June 2012. Factors were classified under 11 topics and evaluated according to their relationship with the mortality rate. ResultsThe major causes of death in burn victims were multiple organ failure and infection. Twenty-six percent of the 101 patients died, all of whom were male. One (1.4%) of the patients who survived was female; 73 (98.6%) survivors were male. The mean age in the deceased group was statistically higher than that of the other patients (32.7 vs. 35.6 years; P<0.05). All-cause mortality was 2.79 times higher for larger burns (>25% total body surface area). The values for creatine kinase, creatine kinase-MB, total body surface area of burn, hospitalised period in the intensive care unit and intubation rate were significantly higher in the exitus group. Renal injury requiring haemofiltration was associated with an almost 12-fold increased risk for mortality. There was no statistically significant difference between patients regarding surgical interventions. ConclusionElectrical injury remains a major cause of mortality and long-term disability among young people. Our data demonstrated several risk factors associated with increased mortality rate in patients with electrical burn wounds.

Hypercoagulability after burn injury

Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery. A prospective observational trial was conducted at an American Burn Association verified Burn Center. Thromboelastography (TEG) was performed on blood drawn from indwelling catheters upon admission and weekly for those who remained hospitalized. Routine and special coagulation tests were performed on stored samples. Data are expressed as median (interquartile range). Twenty-four patients (88% male) were enrolled, with a median age of 49 (20) years and a median total body surface area burn of 29% (23%); 21 experienced thermal burns (4 inhalational injuries), and 3 had electrical burns. There were no significant differences in TEG or coagulation assays between patients with thermal versus electrical burn injury, but there were significant differences between men versus women and between those with or without inhalational injury. Sixteen patients had repeat samples 1 week after intensive care unit admission. The repeat TEG was more hypercoagulable (all p < 0.05). Fibrinogen and natural anticoagulation proteins (protein C, protein S, and antithrombin III) were also increased (all p < 0.05). Two patients (8%) developed venous thromboembolism (VTE); TEG reaction time, fibrinogen, and partial thromboplastin time were decreased (all p < 0.05) at admission compared with those with no VTE. All changes occurred despite pharmacologic thromboprophylaxis. There was no significant correlation between TEG and total body surface area or between TEG and fluid balance. In general, burn patients have normal coagulation parameters at admission but become hypercoagulable during recovery. However, those who are hypercoagulable at admission may have an increased risk of VTE. Additional monitoring and/or thromboprophylaxis may be indicated. Epidemiologic/prognostic study, level III.

Should serum creatinine kinase levels and an ECG be routinely obtained in low voltage electrical burn injuries?

Background Initial excess of creatinine kinase (CK) has been shown to correlate with extent of muscle damage in electrical burns.[1] High voltage burns leading to extensive muscle damage, compartment syndrome and rhabodmyolysis is clinically apparent at an early stage. However, the frequency of these injuries is rare. Low voltage (<1000V) injuries from domestic appliances are far more common with few if any clinical signs. In order to develop a local guideline, the current practise of investigations ordered in our department was analysed.

Supraclinoid internal carotid artery–inferior petrosal sinus arteriovenous fistula after high-voltage electrical burn injury

High-voltage electrical burns can cause immediate and long-term neurological and cerebrovascular injuries. The authors present a 21-year-old man who developed an intracranial arteriovenous fistula secondary to high-voltage electrical injury. CT angiography demonstrated a left supraclinoid internal carotid artery (ICA)–inferior petrosal sinus (IPS) fistula. A subsequent angiogram revealed an irregularity of the cavernous and supraclinoid ICA with stenosis involving the supraclinoid segment and a fistulous connection between the ICA and IPS distal to the ophthalmic take-off and proximal to the anterior choroidal artery. The patient underwent a decompressive hemicraniectomy and clip-wrapping of his ICA pseudoaneurysm with successful obliteration of the fistulous connection. To our knowledge, this is the first report of an intracranial arteriovenous fistula secondary to an electrical burn injury.

English

Electrical burn injury is one of the most destructive injuries seen in the casualty room of any hospital. It is a special type of injury with potential of causing significant functional disability and extensive disfigurement. This retrospective study was conducted in the Burn Unit of Sri Aurobindo Institute of Medical Sciences, Indore, a leading tertiary care centre of Central India. This study was done by us to know about the demographic pattern of victims of electrical burn in our area. We wanted to quantify the loss of life due to electrical injuries and assess the degree of disability in the survivors .This retrospective epidemiological study was conducted on patients of electric burn, admitted between Jan. 2007 and Nov. 2012 in our burn unit. We have studied 67 patients of electric burns in this study. Most of the human and economic losses caused by accidents leading to the electrical burn injuries could have been prevented. Prevention of these accidents can be done increasing social awareness and observation of basic and simple precautions by an individual which can be imbibed with the primary education.

Electrical Injuries in Urban Children in New Delhi

The objective of this study was to analyze the epidemiology, presentation, management, and complications of electrical burn injuries in urban children. Data from records and clinical data were collected retrospectively and prospectively during 2008 to 2010. Of 41 children enrolled, the mean age of children enrolled was 8.1 ± 4.5 years. Low-voltage injury was seen in 28 (68.2%), and 13 (31.8%) had high-voltage injuries. Low-voltage injuries were most commonly (52.45%) secondary to direct contact with live wire, whereas high-voltage injuries in 70% were due to direct contact with broken wires lying in fields/rooftops. Fourteen children of the 41 enrolled had associated injuries. Low-voltage injuries were associated with minor burns, seizures, tibial fracture, eyelid burn, scalp hematoma, and speech and visual impairment, whereas high-voltage injuries were associated with cardiac arrest, extradural hematoma, visceral burns, pulmonary hemorrhage and hypoxic encephalopathy, and postelectrocution acute respiratory distress syndrome. Surgical interventions done included split-thickness skin grafting, fasciotomy, and amputation procedures. The mean duration of hospital stay of all the children enrolled was 9.02 days with 35 children discharged, 71.4% of them having low-voltage injuries. Four children died, 75% of them having high-voltage injury, whereas 2 children left without medical advice, both having low-voltage injuries. Children are a major group susceptible to electrical injuries in our country. Most of the mechanisms leading to them are easily preventable, but occur because of lack or awareness among the children and their guardians. Burn prevention program should be implemented incorporating these epidemiological data.

Burn Victim

Burn injury is one of the most catastrophic injuries that the human body can sustain and still survive. Burn injuries are extremely costly to individuals, communities, and employers. Severe burns in children can result in prolonged suffering, disfigurement, and impaired physical and mental development. The goals of burn rehabilitation include helping the patient return to the highest level of function and independence possible while improving the overall quality of life, physically, emotionally, and socially. Children in Ukraine with severe and debilitating burn injuries often do not receive needed medical treatment because of limited resources in Ukrainian hospitals and/or the cost of treatment. Doctors Collaborating to Help Children is a nonprofit organization that works to improve the care of burn-injured children in Ukraine. In the past 5 years, we have been able to bring 14 children from different regions of Ukraine to Shriners Hospital in Boston for treatment. Alex S. is one of the burn victims who is thriving as a result of his care. He had an accident 7 years ago when he went fishing in Ukraine. His fishing rod touched a power line, and he was hit with 10,000 V of electric shock. He was holding a fishing rod with his right hand, which was touching his right shoulder. Alex had a high voltage electrical burn injury third and fourth degrees, 25% TBSA involving his right upper and lower extremities, head, and trunk. His right forearm had to be amputated. He spent 2 months in the intensive care unit in critical condition. Alex went through prolonged treatment and prosthetic rehabilitation of his right arm at Shriners Hospital for burned children in Boston. He had more than 20 surgical procedures and is now able to resume normal life. Currently, Alex is a high school junior in Massachusetts. His interests include rowing, martial arts, web design, and painting. Alex started to paint with his nondominant left hand and has received a lifetime scholarship to the Museum of Fine Arts (Figures 1 and 2). He maintains and designs the Web site for Doctors Collaborating to Help Children (www.dctohc.org).

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Introduction: Over 125,000 children sustain burn injury every year in the United States. Severe burn injury carries significant morbidity and mortality in children. Mortality of electrical burn is not well known in pediatric population. Electrical injury can cause severe muscle damage leading to high mortality. Objective of this study was to determine the mortality of severe electrical burn in children with burn size greater than or equal to 30%. We looked at the demographics, cause of burn, % burn size, length of hospital stay and mortality. Hypothesis: Hypothesis of this study was that the mortality of severe electrical burn in children with burn size greater than or equal to 30% is higher than the mortality of all burns in children with burn size greater than or equal to 30%. Methods: Patients admitted to our burn center with burns greater than or equal to 30% from January 2002 to December 2011 were reviewed, and children with electrical burn were compared to children with all burn injury. Results: A total of 739 patients with burns greater than or equal to 30% were admitted to our burn center from January 2002 to December 2011. Of these, 63 children had electrical burn (8.5%). 58 (92.1%) were males and 5 (7.9%) were females. The average age was 12.59 years old (11 months old to 18 years old). Average total burn size was 50.2% (30% to 81%), and average third degree burn was 33.5% (0% to 79.5%). Average length of hospital stay was 28.7 days (3 to 284) or 0.57 day/% burn. The mortality rate was 3.2% (2/63) for children with electrical burns greater than or equal to 30% compared to 8.3% (61/739) for all children with all burns greater than or equal to 30%. Conclusions: Mortality in children with severe electrical burn with burn size greater than or equal to 30% is 3.2% with average length of hospital stay of 28.7 days. Despite low mortality, meticulous care should be provided to children with electrical burn injury.

Design strategies to mitigate the hazard of button cell battery electrical burn injuries

BackgroundChildren's exposure to button cell batteries is increasing with the greater number of toys and other consumer products requiring their use. Children frequently mouth objects and may inadvertently swallow them....

Lowering the pivot point of sural neurofasciocutaneous flaps to reconstruct deep electrical burn wounds in the distal foot

Due to the thinness of the skin and soft tissues in the foot, tendons and bones tend to become exposed and necrotic after injury; therefore, it is difficult to reconstruct foot injuries, especially distally. Reconstruction with free skin flaps is highly risky as it demands technologies and equipment, while patients suffer greatly from the use of cross-leg skin flaps. Sural neurofasciocutaneous flaps are often used for reconstruction of wounds in the lower leg, malleolus, and the proximal end of the foot but are not feasible for wound repair in the distal foot; this is because, with the pivot point of 5–7cm above the tip of the lateral malleolus, the flaps are not able to cover defects in the distal foot. In this study, we used a sural neurofasciocutaneous flaps with a lowered pivot point for reconstruction of distal foot wounds caused by electrical burns. An ultrasound flow detector and Doppler flow imaging were used to detect the diameter, the perforating point and the blood flow of the lateral retromalleolar perforator. Twelve patients with the perforator diameter greater than 0.6mm and the peak systolic flow more than 0.15m/s were included. The pivot point of sural neurofasciocutaneous flaps was lowered to 0–3cm above the tip of the lateral malleolus and the size of the flaps ranged from 6cm×5cm to 12cm×18cm. Eleven of the 12 flaps survived completely. One flap developed necrosis approximately 1cm at the far point but was managed successfully by daily dressing. We demonstrated that lowering the pivot point of sural neurofasciocutaneous flaps is feasible for reconstruction of distal foot injury with the advantages of reliable blood supply and easy operation. The use of Doppler flow imaging provides useful information for the design of the flaps.

Effect of Lidocaine on Reducing Injury in a Rat Electrical Burn Model

Electrical injuries induce progressive tissue loss. We evaluated the effect of lidocaine on tissue necrosis after electrical burn injuries. Forty-two male Wistar albino rats (250-300 g) were divided into 3 groups [Group A (n=6), control group without an electrical burn injury; and Groups B (n=18) and C (n=18), electrical burn injury groups without and with lidocaine therapy, respectively]. Three separate analyses were performed at different time points on 6 of 18 rats from Groups B and C at each time point. Electrical burns were induced by applying 220 V AC between the left upper and right lower extremities for 10 seconds. Myeloperoxidase and malondialdehyde levels were measured in skin and muscle biopsy specimens after the first hour, fresh and dry weight differences in the amputated extremities were calculated after 24 hours, and live and necrotic tissue areas were measured at 7 days after burn injury. We found that lidocaine reduced edema, the number of neutrophils, and neutrophil damage in tissues. We conclude that lidocaine decreased the amount of necrotic tissue caused by electric injury.

PNEUMOTHORAX FOLLOWING ELECTRICAL BURN INJURY: A CASE REPORT

Electrical injuries are a common occurrence and they can be very trivial or fatal depending on the voltage.Electrical current causes tissue damage by producing heat due to local tissue resistance. Sometimes patients present with visceral damage, organ perforation or pneumothorax. Pneumothorax as an immediate complication of electrical burn injury is a rare entity since, it usually develops two days after significant electrical injury. We report one such treated case of electrical burn injury with right sided pneumothorax as an immediate complication.The outlook is very good in patients who survived the initial electrical exposure and received prompt treatment of complications.

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

An area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion. From January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling. The mean age of patients was 49.9±12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6±36.7 cm(2). The mean expansion duration was 65.5±5.6 days, and the inflation volume was an average of 615±197.6 mL. Mean defect size was 122.2±34.9 cm(2). The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision. Successful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

First aid in burns

Objective: The objective of this study was to evaluate the etiological factors, nature and pattern of injuries, early and late morbidities of injuries, corrective surgeries, and final outcome and rehabilitation in pediatric electrical burns. Materials and Methods: This study includes 53 children, below 14 years of age. All children, irrespective of severity of injuries, were admitted, assessed, and treated. The charts of pediatric patients who had been admitted to the authors' Centre with electrical burn injuries from January 2006 to December 2011 were reviewed retrospectively. Etiological factors, nature and pattern of injuries, early and late morbidities of injuries, corrective surgeries, and final outcome and rehabilitation were evaluated. Results: Injuries resulted from biting an electrical cord (n = 8), placing an object into an electrical socket (n = 7), coming in contact with a low-voltage wire or appliance indoor (n = 18), coming in contact with a high-voltage wire outdoors (n = 17), e.g., while flying a kite (n = 3). Most of the injuries occurred at the age between 4 and 7 years. Sixty-seven percent of the patients having electrical burns were boys and 33% were girls (M:F, 2.1:1). Most of the injuries occurred between 12:00 and 6:00 PM (51%) and most common organs involved were trunk and upper limb (30%). A 100% skin graft take was recorded in 14 patients (78%) on day 4 postoperatively. Three patients (17%) required partial regrafting and one (5%) experienced a complete loss, which was resolved with regrafting. There were no flap losses. Four amputations were performed and three patients did not survive. Conclusion: The study revealed that if the basic principles of early and adequate resuscitation, proper wound care, maximum tissue preservation, early wound coverage by proper reconstructive procedures, and appropriate rehabilitation are adhered to, there will be a successful outcome for patients with these injuries. Almost every child with high-voltage current injury had a bad prognosis due to the severity of the injury.

Reconstruction of a Severe Chest Electrical Burn Injury, Case Report

The aim of this case is to show the usefulness of early debridement and resurfacing of burn injuries in difficult areas like the chest wall. The successful techniques of using a Lattisimus dorsi myocutaneous flap in the management of this case represents a good reconstructive method to be applied.

Sympathetic skin response in electrical burn injury

BackgroundElectrical burn has been reported to be highly associated with peripheral neuropathy. This study was designed to evaluate the sympathetic skin response (SSR) of electrical burn patients to determine whether the sympathetic nervous system is involved in these patients. Materials and methodsThe sympathetic skin response of 28 patients, suffering from electrical burn injury (divided into two groups of high voltage and low voltage exposure) was compared with that of 28 matched subjects, who had never experienced electrical burn. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to Median and Tibial nerve electrical stimulation. ResultsSSR in all recording sites of the electrical burn patients compared showed significantly more prolonged latencies and reduced amplitudes, with their counterparts in the control group with no significant difference between the high voltage and low voltage electrical burns. There was no significant difference in SSR latency, between the entry and exit sites of the electrical current. The SSR amplitude however, showed more reduction in right hand than the left one, in whom the electrical current had entered the body from the right hand. The time lapse between the electrical burn and the SSR study was shown to play no role in the results. DiscussionIncreased SSR latency in electrical burn injury may be a sign of autonomic nervous system involvement, through systemic responses to electrical burn.

Fucoidin, a neutrophil rolling inhibitor, reduces damage in a rat electrical burn injury model

Background Electrical injuries induce progressive tissue loss caused by free oxygen radicals released from neutrophil aggregates. Fucoidin, a potent inhibitor of L-selectin function, reduces the aggregation of neutrophils. The aim of this study was to evaluate the effect of fucoidin on tissue damage in rat electrical burn injury model. Methods Forty-two male Wistar albino rats (250–300 g) were divided into 3 groups (Group A ( n = 6), control group without electrical burn injury; Groups B ( n = 18) and C ( n = 18), electrical burn injury groups without and with fucoidin therapy, respectively). Three separate analyses were performed at different time points on 6 out of 18 mice from Group B and C at each time point. Biochemistry (myeloperoxidase and malondialdehyde levels) and histopathology (number of neutrophils) of the skin and muscle biopsies at 1st hour; tissue edema (ratio of wet weight/dry weight of extremities) at 24th hour; and necrotic areas at 7th day after electrical injury were evaluated. The electrical burn was induced by exposing rats to 220 V AC between their left upper extremity and right lower extremity for 10 s. Fucoidin was administered as 25 mg/kg intravenous bolus injection at 15 min after electrical burn injury. Results Myeloperoxidase and malondialdehyde levels, number of neutrophils, tissue edema, and necrotic area were significantly less in fucoidin-applied rats than the group without fucoidin therapy. Conclusions Fucoidin inhibits tissue damage induced by electrical burn injury in rats by reducing necrotic area, edema and number of neutrophils.

El Parmak Defektlerinin Onarımında Güvenilir ve Kullanışlı Bir Flep:Ters Akımlı Dorsal Metakarpal Arter Pediküllü Flep

Reverse flow dorsal metacarpal artery pediculled flap is one of the easily apllicable and useful flap alternatives which are used for closing the defects of the hand fingers. The aim of this study is evaluate complications and outcomes of finger defects repairing with reverse flow dorsal metacarpal artery pediculled flap. From 1999 till 2009 we applied this technique for repairing fingers’ defects in totally of 15 patients. 5 of them represent after electric burn injury, 4 after endustrial trauma, 4 after excision of squamous cell carsinoma ( SCC ) and 2 after contracture opening procedure. Nine of them were male and 6 female with mean age of 39. Most of used arteries were 2nd or 3rd dorsal metacarpal. Follow ups for these patients lasted around 30 month (11 - 45 month). In 2 patients flaps were lost due to inappropriate pedicle rotation and after the debridement of the flaps, the defects were repaired with “cross-finger” flaps. Reverse flow dorsal metacarpal flap which does not damage the major arterial system of the hand and is easily applicable and useful technique, has good skin color and tissue compatibility, and can be used for fingers’ defects repairing.

Transcranial magnetic stimulation can diagnose electrical burn-induced myelopathy

Introduction We conducted motor- and sensory-evoked potential analyses and investigated their diagnostic value in differentiating between electrical burns without evidence of neurologic injury and those with clinical evidence of myelopathy. Methods We studied high-voltage electrical burn injury patients with lower extremity weakness and evidence of myelopathy and those without any evidence of neurological complications. Motor-evoked potentials (MEPs), somatosensory-evoked potentials (SEPs), and MRI studies of the spinal cord, as well as transcranial magnetic stimulations, were performed. The central motor conduction time (CMCT) was also calculated. Results The upper limb MEP and upper and lower limb SEP variables did not statistically differ between the 2 groups. The CMCT and total motor conduction time recorded in the lower limb were delayed in the burn myelopathy group. MRI revealed no abnormal signal changes in myelopathy patients. Conclusion Our study demonstrates that MEP is useful in identifying myelopathy in patients who have sustained high-voltage electrical burns.