High-tension Electrical Burns Research Articles

Bilateral shoulder disarticulation after high-tension electrical burns: a case report

Background: High tension electrical burns are rare but devastating injuries with high mortality usually from overwhelming sepsis, poor cardiovascular support and multiple organ dysfunction syndrome (MODS). However, survivors of such burns have varying degrees of injuries with significant morbidity especially after radical amputation to save their lives. The objective of this case report was to present this rare scenario and highlight the importance of prompt intervention and acute surgical management that improves survival. Case report: This was a descriptive case report of a 23-year-old male, a survivor of high-tension electrical burns (11,000volts) to both upper limbs. He had immediate admission into the intensive care unit with ventilatory support and multi-disciplinary approach to care. He had some investigations which included daily full blood count, serum electrolytes, urea and creatinine, clotting studies, blood sugar, urine analysis, lactate level, iron and creatine kinase studies, chest x-rays, electrocardiogram and abdominopelvic scan. He had multiple blood products transfusion; antibiotic therapy, staged surgeries including bilateral shoulder disarticulation to control sepsis and preserve life. He was discharged home with healed disarticulated shoulders and satisfactory clinical condition after 35 days on admission. Conclusion: Early resuscitation, cardiovascular support in the intensive care unit, urgent wound debridement and amputation of devitalized limb were life-saving interventions. These prompt care improved his survival chances following high -tension electrical burns.

Epidemiology and acute management of high tension electrical burns in a rural-based medical college

Introduction. Electrical burns are one of the most common causes of burns besides flame burns and scalds. High tension electrical burns lead to greater morbidity and mortality. Active management strategies are required to manage high tension electrical burns. Common epidemiological features and surgical management of wounds are described. Role of high ligation in high tension electrical burns has been described.Purpose. To describe the epidemiology, main features of the presentation and acute management of high tension electrical burns.Materials and methods. This study was done for the duration of 2 months. All patients who were admitted with high tension electrical burns were included in the study. Patients’ demographics, mode of injury, % age of burn areas involved, entry-exit wounds were recorded on the day of admission. Emergency fasciotomy was done in cases of impending gangrenous changes inlimbs to prevent compartment syndrome and peripheral neuropathy. Reconstructive surgeries were done depending on thelocation and depth of burns. Results. 64% patients were below 30 years. The majority of the patients who sustained electric burns were males (82.3%). All the patients were from low and middle socioeconomic status according to the modified kuppuswamy scale. The majority of patients sustained electric contact burns (55.8%). The majority of the patients were unskilled workers working in the fields (94.2%). Surgical treatment of all patients includes fasciotomies in 15 patients, debridement/ amputation in 32 patients, reconstructive surgeries in 42 patients.Conclusion. High tension electrical burns are one of the most common causes of burns, especially in rural areas. Public awareness and compliance with safety standards as well as respect for the potentially deleterious effects of electricity are of utmost essential for avoiding these deadly injuries.

Using Delay Principle to Create Two Viable Flaps Within one Distant Pedicled Flap: How We Did it-A Case Report.

From the time reconstruction is being performed, delay is a part of standard surgical staged procedure, wherein the procedure results in inducing ischemia to the tissues and hence flap viability.[1] We present here a case, wherein we did a delay from the distal margin of an elevated flap, which bisected a single flap into two flaps to provide cover to two different regional defects with one flap acting as a distant pedicled flap and the other as a local transposition flap. A 24-year-old man presented with high-tension electrical burns with multiple exposed bones at multiple locations. The patient had 4-degree burn with an exposed left iliac crest bone and an exposed ulnar bone ([Fig. 1A, B]). The patient was planned for a single pedicled thoraco-umbilical flap (TU flap), which could cover both the ulna and iliac crest bones, the intention was to resurface two exposed bones with a single pedicled flap of two different anatomical regions. After 3 weeks, the flap was delayed from the distal margin and bisected from the middle of flap to produce two different individual flaps to resurface both the exposed bones without any pull in the opposite direction; hence flaps were lying snugly on their respective position ([Fig. 2]). The delay to bisect the flap was done in two stages of 5 cm, 7 cm length, respectively, with an interval of 1 week. After bisecting the whole flap, the inset was given to cover both the defects without any tension ([Fig. 3A, B]). The mechanism of delay makes the flap ischemic, wherein the length to breadth ratio of the harvested flap tissue may also be increased.[2] [3] Partial inset requires a staged delay that will help in increasing the dilatation of the existing vasculature, with proliferation in the choke area;[4] also, it obtains perfusion from the recipient bed. Most of the time, the standard practice of performing delay is from the base of the flap; in our case, a TU flap with the per umbilical perforator being the main supply was elevated. The delay principle was used in bisecting the flap in the middle with an intention to increase blood supply[5] in both halves of the flap to create two different flaps. Being an electrical burn, we were skeptical to perform a microvascular flap, in view of the high rates of failure due to intimal vascular damage. Delay done from the distal margin of the flap has been described for the first time. We conclude that the principle of delay may be applied in creating two viable flaps within one distant pedicled flap, with adequate care being taken on the timing of delay, length of incision on the flap, and the area of inset given on the defect.

Management of wrist electrical burns with utilisation of recent modalities for better functional outcome

Abstract Background: The aim is to study the sequence of events contributing the survival of wrist electrical burns and reconstructive options for salvage of soft tissue of electrical burns of wrist. Methods: Data of patients with high tension electrical burns involving the wrist admitted in our hospital from January 2018 to December 2020. There were 17 patients with electrical burns with wrist injury. Patients from age 18 to 65 years were included in the study. Patients were subjected to bio immunoassay, infrared thermography, indocyanine fluorescent scan, hyperbaric oxygen therapy and reconstructive procedures. Results: Among 17 patients, 16 were male. Their age ranged from 20 to 61 years. The injury resulted from 11 kv voltage line most often and the patients were admitted within a day of injury. All patients were subjected to multiple staged procedures of debridement and reconstruction. 7 patients were subjected to amputation of the limb, 5 patients subjected to reconstruction in terms of abdominal flap and 4 with groin flap and one perforator plus flap was used to cover the wrist defect. Conclusions: Wrist electrical burns due to its crucial location, requires knowledge on disease process, if ignored will directly lead to significant morbidity. Utilisation of newer modalities will help in timely intervention and salvage of the limb.

Frontal bone osteomyelitis following electrical burn injury

Osteomyelitis of the frontal bone is an uncommon clinical presentation that usually occurs as a complication of trauma or sinusitis. An electrical burn injury of the scalp region leading to osteomyelitis of the skull bone is an extremely rare clinical presentation. An 8-year-old boy reported nonhealing forehead wounds for the last 6 months due to accidental contact with high-voltage power line. Clinical and radiological examination confirmed the diagnosis of osteomyelitis of the frontal bone. He underwent sequestrectomy of necrosed bone followed by soft-tissue reconstruction of the defect with local flap to achieve good wound healing and satisfactory cosmetic outcome. High-tension electrical burns resulting in severe injuries to the scalp, calvarium, meninges, and brain are among the most serious complications of burns. A proper diagnosis and early and aggressive surgical intervention is of utmost importance for management of skull osteomyelitis.

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns: A Retrospective Case Series

ObjectiveThe objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns. MethodsWe collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits. ResultsThe injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up. ConclusionTreating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage.

Background:While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery.Materials and Methods:The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years.Results and Conclusion:Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.

Abstract: High Voltage Electrical Burn Injuries of Hand in Children: A Clinico-Aetiological Study and Role of a Doctor in Its Prevention

INTRODUCTION: Electrical burn injuries are very devastating and are always a challenge for reconstruction and rehabilitation.1 Children are generally at high risk because of their natural curiosity to explore things.2,3 Once injured and amputated at this learning age, they are unable to attend school and fall behind their peers and ultimately affecting their capability to earn a livelihood. OBJECTIVE: This study was undertaken to analyse the burden of high voltage electrical hand injuries, aetiological factors, pattern of injuries, to contemplate the various preventive measures and to discuss and promote the role of doctors especially hand surgeon in its prevention. MATERIAL AND METHODS: The study included 83 children below the age of 14 years with high voltage electrical injuries admitted in the hospital from Jan 2010 to Dec 2014. Out of these, 75 patients had injury to their hand which resulted in partial or complete amputaions (32+43). All children were evaluated for etiological factors, pattern of injuries, educational status of the child as well as parents and intervention done. A study specific 10 point questionnaire was prepared to gain insight into the etio-sociological parameters associated with these injuries. Simultaneously an awareness campaign educating the population at risk was initiated (with hand surgeon as the chief campaigner along with few treated patients to play as role model). This included outreach programs in areas from where there was high patient input as well as educating the family of the patient at the time of discharge and every follow up. RESULTS: Most common cause was accidental contact with the overhead high voltage live wire. Other reasons were illegal connection with high tension wires and transformers, coming in contact with broken live wires in fields, kite flying and railway tract accidents. Most common age group affected was 10 to 14 years. In the last one year it was found out that those areas in which special camps were organized had a statistically significant drop in the incidence of these injuries. CONCLUSIONS: The incidence of high voltage electrical injuries is higher among the uneducated & unsupervised children. This study emphasizes the role of doctor in prevention of these crippling catastrophic hand injuries by identifying and educating the population at risk and more importantly saving the hands of future. DISCLOSURE/FINANCIAL SUPPORT:None REFERENCES 1. Edich RF, Farinholt HM, Winters KL et al. Modern concepts of treatment and prevention of electrical burns. J Long Term Eff Med Implants 2005; 15: 511–32. 2. Nafs F, Aromir F, Carreira S et al. High tension electrical burns: a review of 85 patients. Eur J Plast Surg 1993; 16: 84. 3. Tomkins KL, Holland AJ. Electrical burn injuires in children. J Paediatr Child health 2008; 44: 727–730.

Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study.

AIMTo look into the management options of early debridement of the wound, followed by vascularized cover to bring in fresh blood supply to remaining tissue in electrical burns.METHODSA total of 16 consecutive patients sustaining full thickness forearm burns over a period of one year were included in the study group. Debridement was undertaken within 48 h in 13 patients. Three patients were taken for debridement after 48 h. Debridement was repeated within 2-4 d after daily wound assessment and need for further debridement.RESULTSOn an average two debridements (range 1-4) was required in our patients for the wound to be ready for definitive cover. Interval between each debridement ranged from 2-18 d. Fourteen patients were provided vascularized cover after final debridement (6 free flaps, 8 pedicled flaps). Functional assessment of gross hand function done at 6 wk, 2 mo, 3 mo and 6 mo follow-up.CONCLUSIONHigh-tension electrical burns lead to significant morbidity. These injuries are best managed by early decompression followed by multiple serial debridements. The ideal timing of free flap coverage needs further investigation.

A Case-Matched Controlled Study on High-Voltage Electrical Injuries vs Thermal Burns

The aim of this study was to provide an increased level of evidence on surgical management of high-tension electrical injuries compared with thermal burns using a case-controlled study design. Sixty-eight patients (64 males, 4 females, aged 33.7 +/- 13 years) with high-tension electrical burns were matched for age, gender, and burnt extent with a cohort of patients sustaining thermal burns. Data were analyzed for cause of accident (occupational vs nonoccupational), concomitant injuries, extent of burn and burn depth, surgical management, complications, and hospital stay. High-tension electrical burn patients required an average of 5.2 +/- 4 operations (range, 1-23 operations) compared with 3.3 +/- 1.9 (range, 1-10 operations) after thermal burns (P = .0019). Amputation rates (19.7% vs 1.5%), escharotomy/fasciotomy rates (47% vs 21%), and total hospitalization days (44 d vs 32 d) were significantly higher in high-tension electrical injuries (P < .05). Creatinine kinase levels were significantly elevated during the first 2 days in patients with subsequent amputations. Free flap failure was observed during the first 4 weeks after the trauma, whereas no flap failure occurred at later stages. Local, pedicled, and distant flaps were used in 15% of the patients. The mortality in both groups was 13.2% vs 11%, respectively (nonsignificant). High-voltage electrical injury remains a complex surgical challenge. When performing free flap coverage, caution must be taken for a vulnerable phase lasting up to 4 weeks after the trauma. This phase is likely the result of a progressive intima lesion, potentially hazardous to microvascular reconstruction. The use of pedicle flaps may resemble an alternative to free flaps during this period.

A three-dimensional virtual reality model for limb reconstruction in burned patients

Electrical burns are a common cause of injuries. Despite many developments in the treatment of high-tension electrical burns, this type of injury still shows high-morbidity rates. Recently, the use of free flaps for reconstruction in burned patients has increased due to advances in the field of microvascular free tissue transplantation [1]. Free flaps have reached a high level of sophistication. For instance, reexpanded flaps, composite tissue flaps, fascial flaps, multiple autologous flap transplantations and combined flaps (‘‘chimeric flaps’’) based on a single vascular pedicle have been performed in patients with severe burns and large defects in extremities [2]. Traditional methods of learning have helped generations of surgeons to familiarize themselves with flaps anatomy. Nevertheless, even texts with the highest level of accuracy and image quality are limited by the two-dimensional nature of printed material, which cannot impart three-dimensional (3D) views. Video material is similarly limited as to deliver a 3D experience. Another restriction of most traditional methods for the study of anatomy relates to the lack of interactivity and feedback. As a supplement to the knowledge gained from books and observation, cadaver dissections can play an

Recovery after spinal cord injury due to high tension electrical burns: A 5-year experience

A 45-year-old gentleman was admitted to our burns unit with a history of contact with high tension live electrical wire while sitting and working on an electric pole. He was fully alert and there was no loss of consciousness. Ocular movements, pupillary light reflexes and fundoscopy were normal. BP was normal. He had sustained burns to 20% of the total body surface area. These consisted of full thickness contact entry burns over the scalp, and full thickness exit wounds involving the bilateral inguinal region, penis and scrotum. The scalp and both tables of part of the parietal skull bone were necrotic. There were superficial and deep second degree flash burns over the neck, face, and the chest. On admission he was able to move all the four limbs normally. Urinalysis was positive for hemoglobin. Serum creatinine and electrolytes were normal. Creatine kinase was seen

Contact high-tension electrical burn to the penis: Reconstruction of the defect with free radial forearm fasciocutaneous flap and silicon rod, a case report

Electrical burns are the second most common cause of burns. Despite the most recent developments in the treatment of high-tension electrical injuries, this type of injury which involves the urogenital system continues to present high morbidity rates. High-tension electrical burns to the penis are not common and in surgical treatment, adequate debridement followed by early reconstruction using local flaps and/or free flaps is recommended. The aims of penile reconstruction are to enable urination and sexual function and to reconstruct an aesthetically acceptable penis [1,2]. Multistage techniques in which tubed pedicle reconstruction from abdominal wall or thigh region and transposition flaps, have evolved to one stage procedures like local or free flaps because of the high number of surgical procedures involved, dissatisfaction with the length of time, and poor functional and aesthetic results [3,4]. In this paper, we report a rare case of contact high-tension electrical injury to the penis which resulted in penis amputation and an analysis of possible surgical treatment procedures to find the most appropriate method. It was deemed that the free radial forearm flap would be the best course of action in this case.

Rationale for Reconstruction of Large Scalp Defects Using the Anterolateral Thigh Flap: Structural and Aesthetic Outcomes

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.

Reconstruction of deep cubital fossa defects with exposure of brachial artery due to high tension electrical burns and treatment algorithm

In this paper, we selected eight patients who had cubital fossa electrical burns with exposure or damage of the brachial artery, during the period 2000 to 2004 and formulated an algorithm to salvage upper limbs. We demonstrated the effectiveness of the algorithm to rescue the extremity from amputation and to restore the functional ability combined with coverage of the defects. After initial management with decompression and debridement of the nonviable tissues surrounding the brachial artery, we used local fasciocutaneous flaps or pedicled latissimus dorsi (LD) muscle/musculocutaneous flaps immediately to cover and also to avoid the perforation of this artery with a mean of 5.5 operations and with an amputation rate of 12.5%. When perforation or necrotic focus was seen on the arterial wall without viable tissue around the brachial artery, circulation was restored with vein grafts. Deep defects in the cubital fossa with exposure of the brachial artery should be covered with well-vascularized tissue as soon as possible after serial debridements. If the necrotic focus is seen on the wall of the artery, it often requires a venous graft with flap coverage. In the presence of viable tissue around the artery, however, fasciocutaneous flaps are useful and they reduce the operation time and duration of hospital stay. We treated deep defects with exposure of the brachial artery in the cubital fossa according to our established algorithm. Adherence to this approach precluded dilemmas in the selection of flap types for the management of bulky tissue defects.

Extrapyramidal symptoms following electrical burns—a case report

Neurological damage following electrical burns is an often discussed complication. The spectrum of neurological sequelae includes cerebral injury, spinal cord lesions, peripheral sensory and motor neuropathies [1]. These sequelae may present early or may have a latent period lasting for several days prior to onset of the dysfunction. This case describes primary CNS injury with delayed development of myoclonus and athetosis in a patient who suffered high-tension electrical contact burns. This is an unusual complication and the probable mechanism is discussed.

High-tension electrical burns: special problems and their management

High-tension electrical burns: special problems and their management

High-tension electrical burns: special problems and their management

High tension burn injuries comprise 1% of admissions to burns units and have a high incidence of mortality or amputation of an extremity in patients who survive. A dichotomy regarding treatment rationale for high tension electrically injured patients exists and is supported by two separate views of the pathophysiology of the injury. One view contends that the full extent of the injury occurs at the time of injury and this concept is used to support a philosophy of early radical debridement and reconstruction. Another view is that an element of chronicity exists in wound development and that serial examinations and debridements may be required prior to definitive reconstruction. The treatment rationale presented by the authors is that the high complication rate associated with these injuries, including partial or complete flap failure, as well as the need to preserve vital tissue justifies a cautious reconstructive approach similar to that used in high velocity lower limb injuries with serial examinations and debridements taking place prior to definitive reconstruction. A historical overview and discussion of some of the unique features of high tension electrical injuries is presented and used to support the authors’ philosophy of management.

High tension electrical burns

In this study, 85 patients with high-tension electrical burns who were seen in an 11 year period were reviewed. Only victims with documented passage of high-tension electrical current (more than 1000 volts) through the body were included. A total of 210 operations were performed for exploration, debridement and closures of the injuries; 44 cases underwent a total of 65 amputations. Acute renal failure developed in two cases (2.3%) and both died. No cases of clostridial infection occurred. Four patients (4.7%) died in this series. We came to the conclusion that the primary treatment of these burns must include aggressive fluid resuscitation and early aggressive debridement.

Early Free-Flap Coverage of Electrical and Thermal Burns

Because of the clinical concept of progressive tissue necrosis, the concept of immediate excision and coverage of high-tension electrical burns and deep thermal burns has been a controversial subject. Recent clinical and laboratory research has cast doubt on this concept. We present a series of five patients who suffered severe extremity electrical and thermal injuries in whom early excisions were performed with immediate free-flap reconstruction. Special importance is given to radical debridement of all questionably nonviable tissues, excepting intact tendons, nerves, and bone. In these tissues, anatomic continuity is more important than apparent viability. No infections or wound-healing complications were seen as a result of this protocol. Of eight digital nerves that did not function at the initial examination, five subsequently recovered two-point discrimination of less than 10 mm.