High-voltage Electrical Injury Research Articles

Cranial-entry electrical burns with neurological sequelae: A case report

Cranial-entry high-voltage electrical burn injury rarely occurs. Hence, early presentation is rare. We herein present a case of a teenage male with mainly fullthickness electrical burn injury covering 9% of the total body surface area, with gangrenous mid-fronto-parietal scalp and calvarium, moderate head injury with bihemispheric deficits, and left frontoparietotemporal intracerebral hematoma and exit wounds (right thumb, thigh, and toes). He underwent initial outer-strip and, later, inner-strip corticectomy, covered with splitthickness skin graft (STSG) and bilateral posteriorauricular artery-based flap, respectively, as well as tangential burn wound excisions with STSG and louvre flap cover for the digits. He also underwent right upper eyelid contracture release and tarsorrhaphy. He developed late post-traumatic seizures, which were managed with anti-epileptic drugs. Definitive calvarial reconstruction is underway. Cranial-entry electrical injury had high morbidity and mortality risks. The spectrum of nervous damage causation mimics nervous syndromes and their presentations. Although elaborate surgical and medical care offers the possibility of survival, the neurological and neuropsychological syndromes in the post-acute and rehabilitative phases of care should be taken care of.

Anterolateral Thigh Flap for Low-Voltage Fourth-Degree Electrical Burn Injury With Immediate Radial Nerve Palsy at the Elbow: A Case Report

Abstract While high-voltage electrical injuries usually cause severe burn wounds and axonal polyneuropathy, low-voltage electrical injuries cause limited cutaneous wounds and demyelinating mononeuropathy, of which the median and ulnar nerves are the most commonly involved. We present the case of a 42-year-old man who suffered a 480-voltage electrical injury at his right elbow, resulting in a 24 × 10 cm fourth-degree burn wound and immediate radial nerve palsy. The burn wound was debrided with confirmation and preservation of radial nerve continuity. The wound was covered with a free anterolateral thigh flap and it healed uneventfully. The Tinel’s sign continued to advance at follow-up, and electrodiagnostic studies showed progressive reinnervation. His radial nerve function recovered completely in 9 months. This is a rare case of low-voltage electrical injury with a fourth-degree burn wound and immediate radial nerve palsy. We treated the wound aggressively with early debridement and prompt flap coverage, but conservatively treated the radial nerve injury. The nerve recovery course indicates that it had a “shocked-cooked” injury and served itself as a well-placed nerve graft for the subsequent regeneration. We believe that our successful outcome in this case can provide more insights into the management of such injuries.

598 Reconstruction of Trochanteric Pressure Ulcers with Pedicled Vastus Lateralis-Anterolateral Thigh Flap

IntroductionTrochanteric region is one of the most frequent site for pressure ulcer development. High-voltage electric injuries with neurovascular damage is an important reason of paraplegia. These patients have prolonged hospitalization period and develop cachexia by time. Grade 3-4 sores with thoracanter major of femur exposition generally need flap reconstruction. Musculocutaneous flaps are preferred to cover exposed bone and fill the dead space. Although loco regional flaps such as tensor fasia lata, gluteus Maximus muscle flap have been used for thoracanteric ulcers, these flaps have mandatory muscles for ambulation in the following rehabilitation period. Another disadvantage of these flaps are the possible donor site problems due to pressure loading. Thus, we aimed to used vastus lateralis- anterolateral thigh(VL-ALT) flap for decreasing donor-site morbidity and tension.MethodsBetween 2019 and 2021 we have operated 6 trochanteric pressure ulcers in 5 patients. All patients had history of electric injury related paraplegia. The mean age of the patients was 33 (24-50) The defect size were ranging between 5x4cm and 10x12 cm. Flap size were planned according to exact size of the defect. VL muscle were harvested according to the size of dead space. The donor site was closed primarily in 3 patients. Split thickness skin graft were needed in 2 patients. Patients were hospitalized in lateral decubitus or supine position during follow –up.ResultsMean follow up time was 10 months (6-18). All flaps were survived. Hematoma development were seen in 1 patient in the donor site which were treated with bedside debridement. No recurrence was seen during follow-up period. No restriction or morbidity were encountered during ambulation.ConclusionsVL-ALT musculocutaneous flap provides the required tissue for dead space filling and defect closing simultaneously. The advantages of this flap are; lower donor site morbidity, perfect match in terms of skin quality and bulk, protecting the major muscles such as gluteus maximus and tensor fascia lata. The technique needs knowledge of quadratus femoris anatomy which has a short learning curve.

805 Case Report: Atrial Perforation in the Setting of Electrical Injury and Subsequent Cardiopulmonary Resuscitation

IntroductionElectrical injuries cause 500 to 1000 deaths per year in the United States and are the fourth leading cause of death in the workplace. Rates and types of cardiac complication secondary to electrical injuries vary widely throughout the literature. Case reports describing cardiac perforation in the setting of electrical injury are exceedingly sparse. To our knowledge, there are no documented cases of cardiac perforation as a direct result of electrical injury.MethodsThis is a case report and review of relevant literature.ResultsCase Description:We present a case of myocardial perforation in the setting of high voltage electrical injury. An otherwise healthy 46-year old male sustained a 13.8 kV electrical. Resuscitation included bystander cardiopulmonary resuscitation (CPR), defibrillation by emergency medical responders, finger thoracostomies and massive transfusion protocol in the trauma bay, and finally emergent sternotomy and repair of two injuries to the right atrial appendage. Given this patient’s pattern of injury, including a sternal fracture and bilateral upper anterior rib fractures, the etiology of his right atrial perforation is more likely due to mechanical injury from CPR instead of thermal or electrical injury to the myocardium. However, intraoperative findings confound this theory as no defects were identified in the pericardium of the mediastinal pleura during the operation. This would argue against mechanical injury during CPR. However, the presence of a left hemothorax may could indicate that a pericardial injury was missed in the operation. We argue that the most likely cause of injury is mechanical perforation of the pericardium and myocardium during CPR with a possible missed pericardiotomy during surgical exploration. An alternative hypothesis is an isolated electrical injury to the myocardium and left hemothorax from rib fractures without communication between the two cavities. This patient expired on postoperative day two due to anoxic brain injury.ConclusionsThis case highlights myocardial injury as a rare but lethal complication of high voltage electrical injury and serves as a reminder that cardiac perforation and hemodynamic collapse due to hypovolemic shock can compound and complicate the resuscitation and management of a patient with electrical injury. Further, the widely varying data regarding cardiac complications secondary to electrical injury warrants further investigation and large-scale prospective data.

Challenges in the Rehabilitation Management of a Patient with Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) Secondary to High-voltage Electrical Burn Injury with Multiple Disabilities: A Case Report

A 22-year-old male who came in contact with a high-voltage wire, with entry point at the head and exit points at the ankles, presented with flaccid paraplegia and loss of sensation of bilateral lower extremities with no radiographic abnormalities. Several burn-related medical complications arose during the admission, as well as episodes of demotivation. Bilateral below the knee amputation was done because of extensive burn injuries of the lower extremities. The rehabilitation management for a patient with multiple disabilities needed to be tailored depending on the limitations and needs of the patient at a certain point in time. Despite the challenges, satisfactory results were achieved, through telerehabilitation and employing a multidisciplinary team approach.

Pattern of injury in lightning deaths- A post mortem study in southern Odisha

Lightning is one of the most powerful natural phenomena resulting in high-voltage electrical injury. This study attempts to analyze the different patterns of injury, epidemiological profile, trend and circumstances of lightning deaths in one of the southern region of Odisha. This cross-sectional retrospective study was conducted on the 58 fatal cases of lightning strike autopsied in the department of Forensic Medicine and Toxicology of M.K.C.G. Medical College, Berhampur, Odisha during a period of 5 years (2016 - 2020). Lightning deaths constituted 0.89% of total post mortem cases with a male to female ratio, 3.46:1. Majority of victims (27.59%) were between 41-50 years, from rural background and agricultural workers. A fluctuating trend in lightning deaths is seen. 2016 and 2017 had highest incidence of lightning i.e. 31.03% each. Maximum deaths (29.31%) occurred in the month of June and between 3-5 PM (62.7%). The incidences occurred mostly (94.82%) open areas and 37.93% were working in agricultural land. Only 5.17% victims had taken shelter under trees. Burn injuries (mostly linear) were dominant (84.48%) and involved mostly the chest in 39.66% cases followed by abdomen (36.2%). Arborescent marks were detected in 8.62% cases, other injuries in 22.41% and burning and singeing of hairs in 53.45%. Clothing was torn in 13.79% of victims and ear bleeding in 15.51%. No gross internal injury was seen except SAH in 2 cases. All the victims were brought dead and cause of death was mostly due to cardiac arrest. This study will provide expertise and ideas to medical personnel and various stakeholders for prompt management, prevention of fatalities, solve medicolegal issues and policy making.

A case of electric injury with exposed neck vessels and scapula treated with flaps

In modern times, the use of electricity has increased many times and so has the incidence of high-voltage electrical injuries. The incidence of high-voltage electrical injuries is much higher in developing countries when compared to developed countries, lack of proper transmission systems being the cause. Electric burn injuries lead to debilitating morbidity to the affected patients and are often deadly. In such cases with exposed vessels in the neck, major flaps such as the deltopectoral flap or forehead flap or free flaps increase the hospital stay or two-staged procedures and hence increase the morbidity of such patients. Here, we present a case of a young male patient who sustained an electric injury to his foot, neck, and shoulder, which was managed with the platysma flap and parascapular flap with no donor site morbidity.

The combination of anterolateral thigh perforator flap and other flaps for repairing the extreme circumferential defects on the limb

To investigate the effectiveness of the combination of the anterolateral thigh perforator (ALTP) flap and other flaps for repairing the extreme circumferential defects on the limb. Between October 2016 and June 2019, 9 patients with the extreme circumferential defects on the limb were admitted, which resulted by degloving injury, including 8 males and 1 female with a median age of 42 years (range, 32-65 years). The etiology involved twist injury in 5 cases, traffic accident in 2 cases, and high voltage electric injury in 2 cases. The location of the defects was left forearm in 2 cases, right forearm in 3, left foot in 3, and right foot in 1. The injected wound bed followed by the exposure of bone, joint, tendon, and blood vessel. The dimension of defects was 25 cm×20 cm to 40 cm×28 cm. The period between the injury and admission was 1-12 hours (mean, 5 hours). All contaminated wounds were taken thorough and radical debridement and covered by the vacuum sealing drainage device during the emergency operation. The ALTP flap and the other one flap were tailored according to the dimension of the wound when the wound surface became granulating, including the thoracodorsal artery perforator (TAP) flap in 3 cases, superficial inferior epigastric artery perforator flap in 3 cases, superficial circumflex iliac artery perforator flap in 3 cases. And the donor site was primary closure. After operation, all the flaps survived except 1 case of partial necrosis at the edge of TAP flap and healed after secondary skin grafting, and the wounds in the donor and recipient areas healed by first intention. All patients were followed up 14-24 months (mean, 16 months). The shape of the flap was satisfactory and the texture was soft. There was no abnormal hair growth and obvious pigmentation during the follow-up. Only linear scar was left in the donor area, there was no complication such as abdominal wall hernia, and the activity of hip and knee was not affected. The functional reconstruction of upper limb and ankle was satisfactory, and the disabilities of the arm, shoulder, and hand (DASH) score was excellent in 4 cases and good in 1 case; the American Orthopaedic Foot and Ankle Association (AOFAS) score was excellent in 3 cases and good in 1 case. ALTP flap combined with different flaps can reconstruct the circumferential extreme defects after limb damage in one-stage, which can achieve limb salvage to the greatest extent.

Patterns and Outcomes of High-Voltage vs Low-Voltage Pediatric Electrical Injuries: An 8-Year Retrospective Analysis of a Tertiary-Level Burn Center.

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

Factors associated with mortality, amputation, pneumonia, and skin graft loss among electrical burn patients admitted in a Philippine tertiary hospital burn center from 2013 to 2019

Electrical burns are considered as the most devastating and one of the most common causes of burn admissions worldwide. It is cited as the 4th most frequent cause of admission among burn units worldwide. Approximately 1–20% of admission in the Philippine General Hospital Alfredo T. Ramirez Burn center is secondary to electrical burn. This is an analytic retrospective cohort study identifying factors associated with mortality, pneumonia, skin graft loss, and amputation among electrical burn patients admitted to the PGH ATR Burn Center from January 2013 to December 2019. Survival analysis was performed using Log Rank test and Cox proportional hazard regression model. Data analysis was performed using STATA 14. In this study, significant predictors of amputation identified are the following: compartment syndrome, fasciotomy, number of operations, and involvement of trunk and perineum. Significant predictors of mortality include use of metal rod, compartment syndrome, fasciotomy, total body surface area (TBSA), number of operations and age. The use of metal rod pertains to a patient holding a metal conductor near the power line. Significant predictors of pneumonia include the use of metal rod, time of injury, compartment syndrome, fasciotomy, TBSA, number of operations and time of injury to admission/referral and age. Compartment syndrome secondary to high voltage electrical burn injury is strongly associated with amputation by as much 2.13 fold. Patients who have compartment syndrome have 84.5 fold risk of mortality compared to those patients without compartment syndrome. Every day which passes from time of injury to admission predispose patients to develop pneumonia by 0.42 times. Incidence of electrical burns remain to be high in the Philippines due to the country’s rapid rate of industrialization. Preventive measures such as use of proper protective equipment and public health campaigns should be done to reduce the incidence of electrical burns.

ECG monitoring in high voltage electric injury patients presenting with normal ECG: Time to revisit practice?

Advanced Trauma Life Support (ATLS) recommends prolonged ECG monitoring of patients with high risk factors post electric injuries, for detecting and treating potentially life threatening arrhythmias. We hereby present our experience of high voltage electric injuries (HVEI) patients with high risk factors, managed at a level 1 Trauma Centre. Seven patients of high voltage electric injuries with significant burns (BSA > 10% of 2nd degree and above) were admitted over a year (Jan 1, 2019 to Dec 31, 2019), age ranging from 11 to 51 (median 25 yrs). Six out of seven patients (85.7%) were males. Mode of injury was recreational in one, workplace related in one and accidental in five (71.4%). Six patients had entry wounds in extremities, and three underwent emergency limb saving surgery (all escharotomies). Three patients underwent eventual amputation of injured extremity. Serum creatine kinase was monitored in all and multisystem involvement was seen in three patients; one patient (referred) required haemodialysis due to renal failure. There was no mortality. In all cases, 24 h continuous ECG monitoring was carried out as per ATLS and ERC (European Resuscitation Council) guidelines. There was no episode of paroxysmal or persistent rhythm disturbance in our patients during in-hospital stay or follow up. Review of pertinent literature suggests similar experiences of other authors. HVEI is a rare injury and most centres have reported on their experience with small number of patients as in our study. Currently, continuous ECG monitoring post HVEI seems to be the safe practice for patients with cardiac co-morbidities. Further studies are required to find other subsets of HVEI patients likely to benefit from ECG monitoring, and the clinical significance of ‘delayed arrhythmias’ post HVEI.

Traumatic Pneumocephalus Without Skull Fracture From a High-Voltage Electrical Injury

Pneumocephalus, the presence of intracranial air, most commonly occurs secondary to a traumatic injury. Patients with simple pneumocephalus often present with nonspecific symptoms or with headaches. These patients may have little to no clinically relevant physical examination findings and can be managed conservatively. Tension pneumocephalus can present more acutely as a neurosurgical emergency. On physical examination, patients can present with neurologic deficits or papilledema. Computed tomography is the imaging modality of choice to detect intracranial air. We present a novel case of a simple pneumocephalus in the setting of a high-voltage electrical injury without evidence of displaced skull fracture or dural violation. The identification of unanticipated air within the cranial vault should prompt emergency physicians to determine its etiology which can guide treatment and disposition.

46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis

Abstract Introduction Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group. Methods The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation). Results Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%). The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24). Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p< 0.04). Conclusions Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.

561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report

Abstract Introduction Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes. Methods This case-report was conducted via retrospective chart review of the case presented. Results A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital. Conclusions Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.

Electrical Injuries in Children: A 10-Year Experience at a Tertiary Pediatric Burn Center.

Electrical injuries comprise 4% of cases but have higher morbidity and mortality. This study aims to share our experiences with pediatric electrical injuries and propose strategies to prevent them. The files of pediatric electrical injuries between 2010 and 2020 were reviewed retrospectively. The following were investigated: age, gender, cause, length of stay in the pediatric burn center, total burned surface area, voltage-type, and surgical procedures performed. The patients from low- and high-voltage groups were compared. Eighty-five patients were treated in the last 10 years. Seventy were males, the mean age was 9.9 years, the average length of stay in pediatric burn center was 18.2 days, and the average total burned surface area was 11.7%. Forty-three patients were injured with high-voltage and 42 with low-voltage electricity. Fasciotomy was performed in 25 patients, grafting in 40 patients, and amputation in 12 patients. The most often amputated limb was the right arm/forearm. Psychiatric disorders developed in 24 patients. One patient died. In conclusion, the incidence of high-voltage electrical injuries increases with age. They are more prevalent in males, more often accompanied by additional trauma, and have higher total burned surface area, surgical procedures are performed more often, and hospitalization times are longer. For prevention, precautions should be taken by governments and families, and education is critical.

Modern integrated approach to surgical treatment of patients with defects and deformations following high-voltage electrical injury

To develop the algorithm for correction of defects following high-voltage electrical trauma with revascularized autografts, to assess the incidence and risk factors of postoperative complications. Surgical interventions were performed in 16 men. Autografts were selected considering localization of defect and preoperative ultrasound data on perfusion of donor and recipient areas. We applied a sample with temporary compression of the vessels and ultrasound scanning of arteries and veins (a small-sized Doppler sound indicator of blood flow velocity - MINIDOP, BIOSS). Nine patients underwent microsurgical transplantation of revascularized flaps. Six patients with electrical trauma of the upper extremities underwent transplantation of free skin autografts and transposition of flexor and extensor muscles of the fingers in various combinations. In 1 patient, simultaneous microsurgical graft transplantation and plasty with local tissues were carried out. Microsurgical transplantation of thoracodorsal flap was performed in 2 patients with maxillofacial defect (with preliminary deepidermization of the flap in one case). In 3 patients with traumatic amputation of the penis, 2 patients underwent phalloplasty with a thoracodorsal flap and prefabrication of a radial forearm graft at the first stage. At the next stage, urethroplasty with a prefabricated radial forearm graft was performed. In 1 patient, closure of the penis defect was carried out using scrotal flaps. An integrated surgical approach, the use of free revascularized autografts and adequate postoperative management ensure high-quality aesthetic and functional restoration, improvement of the quality of life and social adaptation of patients with defects and deformations following high-voltage electrical injury.

Cardiac Arrhythmias in Patients with Electrical Injury: Hospital Based Study

Background: Electrical injury and its consequences after exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. The aim of this study was to evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury.
 Methods: All 50 consecutive patients who were admitted in Chitwan Medical College from April 2018 to March 2020 were prospectively studied. Patients were categorized into high and low voltage injury group and their variables were compared.
 Results: The mean age of the patients was 32.3±10.4 years among them 41 (82%) were male. Patients who sustain high voltage electrical injury (>1000V) were 18 (36%) and low voltage injury (<1000V) were 32 (64%). Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.2%, p=0.054), sinus bradycardia (11.1% vs 3.1% p=0.254), ventricular premature beats (5.6% vs3.1%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 84.4% p=0.560) and fatigue (55.6% vs 40.6%, p=0.328).
 Conclusion: In this study few non fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.

STROKE AFTER ELECTRICAL INJURY : CASE REPORT

Electrical injury ranging widely reported caused variety of clinical manifestations including brain. Cerebral infarction is one of the manifestation either after low or high voltage electrical injury. We report the case of 49 – year old male who suffered a household electrical injury (110 – 220 Volt) while he was installing the light bulb. He found unconsciousness with left hemiparesis and also central paresis of the left facial nerve (Cranial Nerve VII). The Head Computed Tomography Scan (CT scan) showed wide infarction at right hemisphere which the territory of right cerebral media artery which can be caused by electrical injury.

14,000 Volt Electrical Injury to Bilateral Upper Extremities: A Case Report

Electrical burns are among the most devastating of burn injuries. High voltage electrical injuries result in extensive deep tissue damage and are associated with multiple complications, long term morbidity, and a high mortality rate. We describe the case of a 47 year-old electric company linesman who suffered a high voltage electrical injury (HVEI) of 14,000 volts to bilateral hands and wrists managed by the Division of Plastic and Reconstructive Surgery at the McGill University Health Center in Montreal, Quebec, Canada. His management included multiple operative procedures, including escharotomies, fasciotomies, serial debridements, and bilateral pedicle groin flaps, and amputation of his left hand.

Veno-arterial extracorporeal membrane oxygenation for electrical injury induced cardiogenic shock support: a case report

BackgroundHigh voltage electrical injury (HVEI) of more than 1000 V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality.We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury.Case presentationA 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 V. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and was transported to the nearest medical centre with severe cardiogenic shock with an ejection fraction (EF) of < 10%.Upon arrival, he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point located on his right leg. Blood pH was 6.8, PCO2 53 mmHg, PaO2 of 57 mmHg, lactate 8 mmol/L, and Troponin 38,000 ng/dl. The EF was 10% with global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR), including cardiac massage and few electrical shocks, he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion.He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO, and underwent decannulation 86 h after initialization. He was discharged on day 27 without any sequelae.ConclusionThe VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these “high-mortality risk” patients.