Circumferential burns to the fingers associated with gold and platinum rings

Two patients sustained circumferential burns to the fingers associated with metal rings. The first case was caused by molten zinc and was treated by early burn excision and split skin grafting, while the second case was an electrical burn caused by a car battery and was treated conservatively.

Nonsurgical management of an electrical burn of the scalp

The remarkable regenerative capability of the scalp reduces the need for skin grafting in electrical burns of this area. We report on a deep 7.5 cm electrical burn of the scalp which healed completely under conservative management with 20% urea compresses, benzoyl peroxide gel, and systemic erythromycin.

When lightning strikes. Pathophysiology and treatment of lightning injuries

Lightning accidents are responsible for several hundred deaths and thousands of injuries each year in this country. Survivors sustain a variety of cardiac, neurologic, musculoskeletal, and dermatologic injuries. Eye and ear injuries are also occasionally noted. Education on how to minimize the possibility of such an accident is the best method of dealing with the problem. When prevention fails, prompt cardiopulmonary resuscitation and supportive treatment for the patient's particular injury are indicated.

Treatment of electrical burns of the oral and perioral tissues in children

The causes, clinical appearance, and sequelae of electrical burns of the oral and perioral tissues are discussed, and a method of using splints to treat children with incomplete primary dentitions is presented for the dental practitioner.

Electrical burns: a five-year experience--1985 Evans lecture

Ninety-four electrical burn patients were treated in a 5-year period at our center. The majority of these patients were males, in both children and adults, with the cause of injury mainly due to misuse, inattentiveness, lack of knowledge, and lack of parental supervision. Two major complications were encountered: musculoskeletal (37.3%), which required major amputations in 71.42%; and acute renal failure in 18.08%. Despite treatment with peritoneal and/or hemodialysis, the mortality rate in these series was quite high (58.82%). In order to decrease these complications, a closer monitoring of the patient and early surgical decompression must be applied. Therefore, to prevent this life-threatening event, measures should be taken by health-care officials and physicians to help educate the public in electrical burn prevention through every available means of communication.

Electrical burns

Electrical injury is unlike other burns because of extensive local destruction of tissue at the points of entrance and exit. Artz likened it to a severe muscle crush injury, whereas Hunt showed that the deep-tissue loss is secondary to extremely high temperatures from resistance of the tissues (skin and bone) to the passage of electric current. Although Joule's equivalent explains the heat exchange (often in thousands of degrees of centigrade) with many variables to be considered, it is usually the voltage that can be determined and probably is the most important factor. High tension (more than 1000 volts) and low tension (less than 1000 volts) and direct and indirect currents all exert differing effects. Arc burns can occur without the patient contacting the electrical source but can be quite destructive. Electrical injury can affect many organ systems, depending on the path of the current. The volume conductor theory explains why extremity burns are much worse than torso burns and why extensive débridement (particularly of periosseus muscle) is usually necessary. The progressive destruction of tissue is probably best explained by small vessel occlusion and possibly also by elevated levels of arachidonic acid in areas of greatest heat production. Antithromboxane agents have halted the progression in experimental animals; muscle biopsies and an increased uptake of technetium Tc 99m pyrophosphate help to determine nonviable tissue that must be débrided. Resuscitation must be aggressive to provide adequate circulatory volume. Normal vital signs should be maintained along with a urine output of 100 ml per hour to overcome the destructive renal tubular effect of myoglobin and hemoglobin products. Control of sepsis and its complications through aggressive wound management is critical for survival. Long-term problems from electrical injury are possible, and efforts at prevention may save life and limb.

Conservative management of electrical burn injury of ureter secondary to laparoscopy

We report on a patient with electrical burn injury of the left ureter secondary to laparoscopy. She was treated conservatively. Despite the large number of laparoscopic procedures performed, only a few cases of ureteral injury have been reported in the English literature.

Management of electrical burns to the abdomen

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Nonsurgical management of burns to the lips and commissures

Our results indicate that the nonsurgical approach in the treatment of burns of the mouth should be considered. The nonsurgical approach is less costly and less traumatic, and it yields a favorable result that is shown to be predictable.

Burns of the hand. Thermal, chemical, and electrical

The principles of emergency management of the burned hand include early estimate of the depth of injury; prevention of unnecessary post-burn sequelae, such as edema formation and joint stiffness; and measures to ensure prompt healing of the wound. A successful outcome requires correct splinting interspersed with early active motion, control of infection with frequent dressing changes, and early referral to a hand surgeon if the wound cannot be expected to heal by two weeks.

Electric burns of the oral cavity

Low-voltage electric burns are the leading cause of electric burn injury in childhood and can result in an injury to the oral cavity that can heal with a noticeable deformity. The mechanisms of burn injuries to the oral cavity are either due to the electric arc or current or both. Electric burns of the oral cavity can involve the lip, tongue, mucous membranes, and underlying bone. Therapy for these injuries should include management of systemic sequelae and treatment of the local burn injury. Our therapeutic approach to this injury is dictated by the pathophysiology of the electric burn of the oral cavity.

Long-term functional results of selective treatment of hand burns

Four hundred seventy-eight patients with hand burns (786 hands) were treated at the burn service of the Massachusetts General Hospital. Long-term evaluation showed that early incision and immediate autografting of deep second degree, mixed second and third degree, and third degree full-thickness hand burns resulted in 93 percent, 95 percent, and 93 percent, respectively, excellent to good functional results. There was no significant differences in results in patients with superficial second degree burns treated nonsurgically with silver nitrate dressings and early physical therapy compared with results in patients with deep second degree, mixed second and third degree, and third degree hand burns treated with early excision and grafting. No patient with fourth degree burns had excellent to good results. Permanent damage was related to extent of original injury to the extensor tendons and joint capsules. On the basis of this broad experience, it is believed that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel.

Lightning injuries

The physical properties of lightning are given, including a description of the different observed lightning forms. The wide variety of effects of lightning on humans is reviewed. In the prehospital care of those struck by lightning, emphasis is upon immediate resuscitation of those who appear unresponsive. Recommendations for emergency department evaluation, treatment, and disposition are given. Guidelines to prevent humans from being struck by lightning are discussed.

Oral splint therapy to manage electrical burns of the mouth in children

Oral electrical burns to the lip commissure are disfiguring injuries for a child. Current treatment includes the use of an orally anchored splint to hold the lip commissures at their correct positions during healing. After wearing an appliance for a period of one year, the burn site is evaluated for the need for corrective surgery (Fig. 9). It has been found that the use of a commissure appliance decreases the need for reconstructive surgery.

Electrical burns of the mouth in children

The acceptable state of the art for commissure electric burns of the mouth in children in the past was to advocate conservative treatment, allowing spontaneous healing to be followed by reconstructive procedures. These statements were made because of the difficulty of assessing the degree of initial injury, the loss of valuable normal tissue in early excision and reconstruction, and the minor role played by infection in healing of local electric burns particularly in this anatomic area. Most authors feel that maximum tissue preservation and functional restoration could best be achieved by delay of surgery until the eschar had separated and the scar had softened. Another school of surgeons believe that scarring, distortion, and secondary infection can be circumvented by timely, early surgical intervention. More recently the fabrication and use of a "dynamic microstomia prevention splint" appears to be beneficial in eliminating the need for or decreasing the degree of surgery in children with electric burns of the commissure of the mouth.

"True" high-tension electrical injuries

A series of 48 patients with high-voltage electrical injuries managed over a six-month period was reviewed. The line voltage at the time of injury was recorded for 40 of the patients, with an average of 14,200 volts. The mean duration from injury to admission was 11 hours. The study group of 48 patients was readily divided into two subgroups: a majority (31) sustained a "true" high-voltage, prolonged contact electrical injury, and a smaller subgroup (17) sustained flash and clothing burns. There was no difference between the two subgroups in the magnitude of voltage exposure. However, patients in the "true" high-voltage subgroup sustained a wide variety of injuries to almost every organ system. Transient EKG abnormalities were noted in 16 patients. The occurrence of myoglobinuria and/or hemoglobinuria was nearly universal and was treated by volume expansion alone without bicarbonate or mannitol. Resuscitation of the "true" group required an average of 7 cc/kg/% BSA of Ringer's lactate. No incidence of acute tubular necrosis was observed. Initial debridement was almost always performed on patients in the "true" subgroup on the day of admission. Flap coverage and/or amputation was required in 70% of these 31 patients. Wound management required an average of 2.4 debridements and 2.2 wound closure procedures. There was no evidence of delayed or progressive tissue necrosis. The principles of resuscitation and aggressive operative management are discussed.

Conservative management of electric burns to the lips of children

Crucial to the proper care of a child sustaining electric trauma to the oral cavity are both a complete understanding of the possible systemic sequelae of this injury and knowledge of the management of the particular lesion. The physical properties of electricity, the systemic and regional effects of electric injuries, and the associated complications are reviewed. The methods of treatment are discussed and the benefit of delaying surgical intervention is emphasized.

Emergent burn care

The estimated 32,600,000 fires that occur annually in the United States produce over 300,000 injuries and 7,500 deaths. Ten percent of hospitalized burn victims die as a direct result of the burn. Initial evaluation and management of the burn patient are critical. The history should include the burn source, time of injury, burn environment, and combustible products. The burn size is best estimated by the Lund and Browder chart, and the burn depth is determined by clinical criteria. Pulmonary involvement and circumferential thoracic or extremity burns require detection and aggressive treatment to maintain organ viability. Hospitalization is usually necessary for adults with burns larger than 10% of the total body surface area (TBSA) or children with burns larger than 5% of TBSA. Major burns, those of 25% or more of TBSA or of 10% or more of full thickness, should be considered for treatment at a burn center, as well as children or elderly victims with burns of greater than 10% TBSA. Lactated Ringer's solution, infused at 4 ml/kg/% TBSA, is generally advocated for initial fluid restoration. After the acute phase (48 hours), replacement of evaporative and hypermetabolic fluid loss is necessary. These losses may constitute 3 to 5 liters per day for a 40% to 70% TBSA burn. Blood transfusion is often required because of persistent loss of red blood cells (8% per day for about ten days). Many electrolyte abnormalities may occur in the first two weeks. Pulmonary injury commonly is lethal. Circumoral burns, oropharyngeal burns, and carbonaceous sputum are indicative of inhalation injury, but arterial blood gas determinations, fiberoptic bronchoscopy, and xenon lung scans are useful for confirming the diagnosis. Humidified oxygen, intubation, positive-pressure ventilation, and pulmonary toilet are the mainstays of therapy for inhalation injury. Wound care is initially directed at preservation of vital function by escharotomy, if restrictive eschar impairs ventilatory or circulatory function. Antibacterial agents may be applied to the burn, but invasive sepsis, defined as greater than 10(5) organisms per gram of tissue with invasion of subjacent viable tissue, requires systemic antibiotic therapy. Wound debridement is done by daily hydrotherapy, tangential excision, chemicals, primary excision, and grafting, tailoring the technique to the individual burn.(ABSTRACT TRUNCATED AT 400 WORDS)

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.

Lightning injury: report of two cases

Two cases of lightning injury which occurred while mountain climbing and took different clinical courses are reported. One case with lightning marks on the abdomen was treated as a crush injury because of myoglobinuria and elevation of serum glutamic oxaloacetic transaminase, lactic dehydrogenase and creatine phosphokinase. The other case had lightning burns and complained of abdominal pain. He was treated with fluid transfusion resulting from superficial and deep dermal burns estimated at 55 per cent of the body surface and received a skin graft. The subsequent three-year follow-up has revealed no residual deformity in either case.

[Conservative management of burns]

The first chapter is dedicated to the frequency and the prognosis of burn trauma, and to the general management of the patient. The second part deals with the pathophysiological basis of the problem and with some controversial facts. The third chapter is a survey of inhalation injury and of electrical burns.

Electrical injuries in children

Electrical injuries in children continue to account for substantial morbidity and mortality. This review describes the responsible pathogenetic mechanisms and five separate types of injury. Multisystem complications are discussed as well as current concepts of patient management. We emphasize the importance of prevention and include a pediatrician's "reminder" list for parent education.