Role of escharotomy and fasciotomy as a first aid measure in the early treatment of an electrically burned arm and wrist

The saving of the hand and forearm of a patient with a deep circumferential electrical burn of the wrist and forearm following contact with 10 000 V AC demonstrates the important role played by escharotomy and fasciotomy in the early treatment of electrically injured extremities.

Early vascular grafting to prevent upper extremity necrosis after electrical burns. Commentary on indications for surgery

Early vascular grafting is the only effective form of treatment for electrical burns of the wrist which are severe enough to impair blood flow to the hand. Failure to appreciate the significance of early changes in blood flow and to take prompt appropriate action may result in the irreversible loss of blood supply and subsequent amputation. This report analyses the problems encountered in six patients where the early signs of impaired blood flow were not appreciated and amputations were subsequently required.

Candida infection in severe burns

Candida infection has become an important cause of morbidity and death in burned or immunosuppressed patients. Two patients with extensive burn complicated with Candida infection are presented, along with the risk factors, diagnostic procedures, and current methods of treatment.

Thermal-crush injuries of the hands and forearms: an analysis of 60 cases

The treatment of injuries inflicted on hands and occasionally forearms by crushing between hot rigid surfaces (thermal crush injury) is usually complex because of the possibility of fractures, nerve and tendon injuries, as well as heat destruction of the skin which also may be macerated. A review of the treatment of 60 patients with thermal crush injuries has defined the more important aspects of treatment including the choice of materials for wound coverage (split thickness skin or tube pedicle tissue graft) and the optimal time for surgical repair of the injury.

Use of autogenous omentum for grafting electrical injury affecting the scalp and skull

A patient with high voltage electrical injury affecting the scalp and skull has been treated successfully using autogenous grafts of the greater omentum.

Hydrocarbon contact injuries

Cutaneous injury caused by exposure to gasoline and other hydrocarbons is a clinical entity with potentially life-threatening effects. We report four cases of such injury. One patient developed full-thickness skin loss following gasoline immersion, and another developed severe systemic complications following contact with a carburetor cleaning solvent. Initial therapy should consist of removal of solvent-containing clothing and extensive lavage or soaking with water, followed by wound care that is generally similar to that used in the treatment of partial-thickness burns. In most cases this includes debridement, topical antimicrobial agents, and dressing changes. Severe pulmonary, cardiovascular, neurologic, renal, and hepatic complications may accompany hydrocarbon absorption, particularly in cases involving gasolines containing lead additives. Therefore immediate surgical debridement should be considered if there is suspicion of continued absorption of toxic compounds from the wound.

Chromic acid burns and acute chromium poisoning

The problems encountered during the treatment of a patient with burns covering 40 per cent of the body surface caused by hot chromic acid and the resulting chromium poisoning are described. Anuria developed on the second day after injury and the patient died on the sixth day.

Tissue deposition of silver following topical use of silver sulphadiazine in extensive burns

Silver sulphadiazine has been applied to the burn wounds of 509 patients during the past 10 years. Eleven patients with burns covering more than 20 per cent of the body surface showed silver deposits in the mucosa of the lips, gingiva and cheeks. The colour of the burn wound was also slightly darker than in patients not treated with silver compounds. This darker colour spontaneously disappeared during the year following discharge from hospital. The pathogenesis of silver deposition has been discussed in relation to other published studies.

Tangential excision of eschar for deep burns of the hand: analysis of 156 patients collected over 10 years

Deep burns affecting the dorsum of the hand have been treated by tangential excision of the eschar in 156 patients involving 208 hands. From our 10-year experience we have concluded that: If the patient's general condition permits it all hands with deep partial and full thickness skin loss burns are suitable for early tangential excision of the eschar. The best time for the operation is within the first week after injury. If the burn is of limited extent and the requirement for autograft skin is small the operation may be carried out under nerve block anaesthesia. When the burn is more extensive (i.e. involving both hands) intravenous ketamine anaesthesia is recommended. During tangential excision sequential layers of tissue must be removed until the base of the burn appears porcelain white in colour, has a lustrous appearance with many small bleeding points and is firm in consistency. If there are deep burns of the finger webs they are incised or excised and then grafted. Postoperatively an absence of fever, pain or exudation from the wound indicates that inspection of the wound can be delayed for about 2 weeks. By this time the wound is usually healed and functional rehabilitation and physiotherapy can commence.

The tangential excision of extensive or deep burns

This report contains our experience gained over 13 years of the tangential excision of burned tissue in 627 patients. We have discussed the indications for and timing of tangential excision, methods of determining the margin between viable and non-viable tissue using histological studies in some patients and the problem of wound coverage after tangential excision.

Clinical experience with Biobrane biosynthetic dressing in the treatment of partial thickness burns

Biobrane, a synthetic, bicomposite wound dressing, has been used to treat 17 patients with partial thickness burn wounds covering 0.5-12.5 per cent of the total body surface area (mean 4.4 per cent). In 16 patients we found complete healing of the wound after removal of the dressing, 6-15 days after the injury. In one patient, the wounds were determined on the third day post-injury to be deeper than initially suspected, and she was taken to the operating room for surgical debridement and grafting. Biobrane is an effective wound covering for clean, superficial partial thickness burns of limited extent; the simultaneous use of topical antimicrobial agents for such wounds is not necessary.

The successful treatment of a patient with extensive deep burns and an open comminuted fracture of a lower extremity

A patient with 95 per cent of the body surface area burned (51 per cent third degree burn) who also sustained an open comminuted fracture of the upper third of the tibia and fibula has been treated successfully.

High tension electrical burns of upper arms treated by segmental excision of necrosed humerus. An introduction of a new surgical method

This paper describes treating high-tension electrical burns of the upper arms by segmental excision of the necrosed humerus. This is a new surgical method of treating local electrical burns. The authors use modification of traditional surgical method, shorten the course of treatment, and preserve the injured limb. However, this surgical method should not be used to treat all high-tension electrical burns of the upper arm, and should be used only under certain conditions. Therefore, it is important to grasp the operative indications.

Verdoglobinuria phenomenon in severe electrical burns

Verdoglobinuria is considered to be an ominous sign of Pseudomonas aeruginosa septicaemia in burns. No report of the survival of a case with this phenomenon could be found in the literature. Stone et al. (1964) first reported verdoglobinuria as an important diagnostic basis for P. aeruginosa septicaemia in burns. A patient with high-tension electrical injury was admitted to our hospital burn department in 1977. Verdoglobinuria occurred. This patient is reported as follows. There was a large defect in the left chest wall with exposure of the heart and secondary P. aeruginosa pyothorax which happened during the early stage of injury. It led to septicopyraemic shock. The patient's urine was examined under ultraviolet rays, the fluorescence was ultrapositive. Verdoglobinuria was positive proof. After active measures were administered, the patient was out of danger from this septicopyraemic shock. The metabolism mechanism of verdoglobin, diagnostic effect of verdoglobinuria on P. aeruginosa septicaemia in severe burns and treatment are discussed.

Early vascular grafting to prevent upper extremity necrosis after electrical burns: II. Experience with wound infection management

Since May 1972, vein grafts have been used to restore circulation in electrical injuries of the upper extremity when the wrist has been the centre of electrical injury associated with obstructed blood supply. Saphenous vein grafts were used in fifteen limbs in fourteen patients where electrical injuries at the wrist threatened complete loss of the hand. Ten of the hands were free of necrosis with motion basically recovered. The other four cases (five limbs) failed in operation for various reasons, resulting in forearm amputations. Clinical practice showed that successful operations depend upon whether secondary infection is effectively controlled, particularly in those who were brought to the hospital late with wound infection and gangrene of the fingers. This paper reviews the measures for controlling postoperative infections in vascular grafting to restore blood flow at the wrist, and the clinical experience gained in treating these patients (six injured limbs of six cases), and preventing amputation. We hope the method could be improved and its use broadened.

Vascular injuries in electrical burns--the pathologic basis for mechanism of injury

These studies present a more complete picture of the pathological changes in injured arteries obtained from patients with electrical injuries affecting the upper extremity. The specific characteristics of vascular injury by electric current proceed from relatively mild to severe in the order of the intima, adventitia and whole-thickness. Vascular injury by electricity is a thermal process extending from the interior to the exterior.

Clinicopathologic observations on tangential eschar excision in deep burns

Clinicopathologic observations on 11 patients with third degree and mainly deep second degree burns treated by appropriately early proper depth tangential eschar excision with adequate coverage by autografts, homografts or vaseline gauze saturated with antibiotics before releasing the tourniquet are presented. The clinical value of the procedure is discussed in the light of the pathohistologic analyses providing pointers for further study of the method and its clinical application.