Electrical burns of the mouth: still searching for an answer

This report is a review of the literature and the clinical experience of electrical burns of the mouth in the West Midlands Regional Burns Unit at the Birmingham Accident Hospital, UK, over the past 10 years. There were five patients, four were children, 9 months to 5 years of age, and one adult. All patients had electrical conduction injuries involving the lips and perioral structures with involvement of the oral commissure. Electrical arc and flash burns were not included in this study. One child had a severe electrical injury and posed a difficult management problem. Although a variety of reconstructive procedures are available, the dilemma between conservative treatment and immediate reconstruction persists. Early intraoral splinting has been suggested in the literature. It was not used in any of the patients in this series and, though it may be beneficial, the patient compliance of a paediatric population may be questionable. The incidence of electrical burns has been on the decline, but those affecting the mouth still continue to be a major problem in management.

Pediatric orofacial injuries

Perioral injuries may have significant medical, dental and psychological consequences in children. Soft-tissue injuries are common-place, with the most common types being contusions, abrasions, lacerations and electrical and chemical burns. Each type requires specific care and follow through. Immediate intervention and treatment are important, and rapid neurologic assessment of a child before treatment helps the long-term prognosis. Children must also be screened for abuse and neglect. The common goal of treatment is to prevent infection, provide function and minimize scarring. Perioral injuries are preventable.

Emergency treatment and early fluid resuscitation following electrical injuries

Injuries caused by high-tension electrical current are rare, but pathophysiologically unique with destructive effects. As a form of thermal trauma, electrical injuries represent a connection of skin burns and deep tissue destruction unpredictable in its depth which mostly resembles a crush injury. Emergency treatment measures begin with the separation from the electrical contact if any and prompt transport to the nearest institution with all means for cardiorespiratory resuscitation and complete recovery. Resuscitation of the patient after electric shock continues then with fluid replacement using special formula modified for such cases, correction of acidosis and myoglobinuria and finally with escharotomy and fasciotomy which is most often necessary.

Environmental emergencies

Recreational activity sometimes leads to injury caused by environmental conditions, such as lightning. A familiarity with the effects of electricity, lightning, hyperthermia, and poisoning is essential for providers of care to the critically injured. This article discusses the pathophysiology and treatment of injuries caused by the environment.

Environmental skin injuries in children

Recently, interest in the potential impact of the environment on our general health has heightened. Particular focus has been directed toward environmental skin injuries because the integument, the only organ of the body that is constantly exposed to the surrounding environment, directly demonstrates the damaging effects of the environment and thereby allows for direct visual recognition by both physicians and laypersons. The characteristic cutaneous features, physiologic responses, therapeutic approaches to promote healing, and preventive measures that may be taken to avoid future environmental injury are discussed. The scope of environmental injuries to the skin is extremely vast; therefore, the focus of this review is limited to cutaneous injuries that may result as a consequence of ultraviolet irradiation, marine life, and electrical forces.

[Biological and molecular biology aspects of burn therapy]

Early wound closure, permanent skin replacement and management of postburn deformities are still unsolved problems in the treatment of burns. However, recent developments in biology and molecular biology provide new possibilities for improved therapy. This includes the enhancement of burn wound healing by growth factors and growth hormone, modulation of immunogenicity of skin allografts by gene transfer, cytokine treatment of burn sepsis and the use of cell membrane stabilizers in electrical injuries.

Burns to the hand

Hands are a common area for burns to occur. Small, superficial burns may need little medical care whereas larger, deeper burns require the services of a specialised burn team and a variety of reconstructive plastic surgical techniques to avoid long-term stiffness and minimise functional loss.

An eleven-year survey of electrical burn injuries

One hundred eighty-six patients with electrical burns were treated within an 11-year period at The Hacettepe University Burn Unit. Both children and adults were treated in this burn unit. The main causes of injury were misuse of electrical appliances, inattentiveness, lack of education in safety precautions, and lack of parental supervision. Treatment consisted of first, normal resuscitation in which Ringer's lactate solution was administered (according to the Parkland formula). Fluid resuscitation was followed by debridement, fasciotomy, and escharatomy. Two major complications were encountered: musculoskeletal involvement in 44% of patients, which required major amputation in 79%, and acute renal failure in 14.51% of patients. In spite of treatment with peritoneal dialysis or hemodialysis, the mortality rate for patients with renal failure was quite high (59%). To decrease the number of complications, closer monitoring of patients and early surgical decompression were applied. The results of this survey demonstrate the need for burn prevention programs in Turkey. Physicians and health care officials have an obligation to educate the public about the prevention of electrical burns. The results of this study and other studies on electrical burns should be communicated to the public through every available means.

A clinical study of electrical injuries

Over a period of 10 years (January 1983 to December 1992), 173 patients with electrical burns were admitted to our Burn Center, constituting 6.8 per cent of acute admissions. There is a relative abundance of data in the medical literature concerning electrical burns, clearly depicting the local characteristics and peculiarities in different countries or societies. Our purpose is to present some statistical, epidemiological data from a Burn Center in China which has a multitudinous population, as well as to compare our data with that from other countries. Our data show that prevention and early wound management of electrical burns are very important in decreasing this incidence and the subsequent tissue amputation rate.

Diagnosis and management of common industrial burns

Workers are at risk for a wide variety of occupational burns, secondary to thermal, electrical, or chemical sources. The diagnosis and management of common industrial burns is reviewed and outlined. Proper evaluation and management is necessary to minimize the disability that can result from these injuries.

Evaluation of treatment modalities in perioral electrical burns

A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results.

Oral electrical burns: etiology, histopathology, and prosthodontic treatment

Oral electrical burns occur predominantly in young children and may lead to permanent disfigurement. The etiology and histopathology of oral electrical burns are discussed. Prosthodontic treatment options are presented to provide clinical guidelines for the practitioner.

The burned hand

Like other work-related injuries, the performance and documentation of a thorough history and physical examination will allow optimal care of the burned worker by accepted management methods. Through understanding of the physical properties of electricity and improving understanding of the pathophysiology of the electric injury, state-of-the-art surgical reconstruction can be appropriately applied. The diversity of chemical compounds at the work place and the wide variety of early measures advocated for treatment requires prevention of chemical burns and careful on-site documentation of chemicals and availability of first aid measures.

Chronically exposed calvarium following electrical burns

Electrical burns of the scalp and calvarium are uncommon, but due to various conditions peculiar to India such injuries are seen frequently. The presentation of such patients at hospital is late because of the paucity of specialized care facilities and understanding of the disease process. Such injuries usually cause necrosis of the scalp and underlying calvarium with sequestered bone being retained in situ by the flimsy adhesions of underlying granulation tissue and overhanging edges of the scalp all around caused by secondary wound contraction. This paper gives our experience of 14 such cases, explaining the reasons for the chronic state and their subsequent clinical management.

Successful treatment of a severe electrical injury involving the stomach

Apparently no report of the survival of a child with severe electrical injuries involving the stomach has been published. We successfully treated a 5-year-old boy with such injuries in August 1991. Our effective treatment included: (1) resection of the necrosis of the stomach immediately after admission; (2) active excision of all surrounding necrotic tissues with conservation of any piece of healthy tissue, including partial degenerative tissues; (3) early coverage of all exposed areas; (4) general comprehensive supportive therapy, and (5) local application of a saline solution containing chloromycetin and lidocaine.

Electrical burns in Kuwait: a review and analysis of 64 cases

Sixty-four patients with electrical burns were admitted to the Department of Plastic Surgery, Ibn Sina Hospital, Kuwait during the past 6 years. There were 1202 admissions during this period, the incidence of electrical burns being 5.3 per cent. Sixty-nine per cent of the patients sustained injury from direct contact with live electrical wire, the remaining 31 per cent sustained flash burns. The incidence of low voltage injury was much higher as compared to high voltage. Forty-four per cent of these injuries were not work related. Less than 10 per cent of the body surface area was involved in about 80 per cent of the patients. A total of 65 operations was carried out in 39 patients. Twenty of these patients had repeated debridements until the wound was ready for coverage. All 64 patients survived.

Management of electrical injuries of the abdomen

High voltage electrical burns may involve intra-abdominal viscera with or without an abdominal wound. The risk of such an involvement is much higher when a wound is present. Depending upon the amount of heat produced vapourization of tissues may occur. If it includes part of the peritoneum, visceral damage is revealed immediately. If it does not occur to that extent, necrosed tissues remain in continuity and visceral involvement remains concealed until slough separates. The prognosis is related to early diagnosis of the associated visceral injury. It is recommended that the debridement should be undertaken at 2-3 days postburn. Laparotomy is indicated if part of the peritoneum is also debrided. Reconstruction of the abdominal wall may be a formidable task. Among the options available, pedicled muscle and musculocutaneous flaps seem to be ideally suited for the purpose.

[Late results of the treatment of eye burns]

An analysis of patients treated in the Ophthalmic Department in Bydgoszcz for eye burns in the 10 years period from 1980 till 1990. Taken into account were the causes of burns, the treatment installed in the early period and in cases of late complications. All the patients were asked to call in for a control examination in order to compare the condition of the eyes at the date of discharge and in the long-lasting time. Among 118 eyes in 91 the visual acuity amounted 0.5-1.0, in the remaining 25 it was only hand movements--0.4. The main causes of low visual acuity were: corneal leucoma, secondary glaucoma, complicated cataract. The eye was enucleated in 2 patients because a painful ocular atrophy developed in the course of the pathological process. These were the cases of thermal burns combined with a mechanical injury. The obtained results were evaluated as sufficiently favourable and comparable to the data of other authors.

Acute management of thermal and electrical burns of the upper extremity

Acute management of upper extremity thermal and electrical injuries requires an aggressive treatment protocol which combines meticulous wound care, intensive hand therapy, and early stable wound coverage to salvage upper extremity function. Electrical injuries inflict severe deep-tissue destruction that frequently results in major limb amputation.