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Poncio MAG, Cruz JJV. 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. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Knuth CM, Auger C, Jeschke MG. Burn-induced hypermetabolism and skeletal muscle dysfunction. Am J Physiol Cell Physiol 2021; 321:C58-C71. [PMID: 33909503 DOI: 10.1152/ajpcell.00106.2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Critical illnesses, including sepsis, cancer cachexia, and burn injury, invoke a milieu of systemic metabolic and inflammatory derangements that ultimately results in increased energy expenditure leading to fat and lean mass catabolism. Burn injuries present a unique clinical challenge given the magnitude and duration of the hypermetabolic response compared with other forms of critical illness, which drastically increase the risk of morbidity and mortality. Skeletal muscle metabolism is particularly altered as a consequence of burn-induced hypermetabolism, as it primarily provides a main source of fuel in support of wound healing. Interestingly, muscle catabolism is sustained long after the wound has healed, indicating that additional mechanisms beyond wound healing are involved. In this review, we discuss the distinctive pathophysiological response to burn injury with a focus on skeletal muscle function and metabolism. We first examine the diverse consequences on skeletal muscle dysfunction between thermal, electrical, and chemical burns. We then provide a comprehensive overview of the known mechanisms underlying skeletal muscle dysfunction that may be attributed to hypermetabolism. Finally, we review the most promising current treatment options to mitigate muscle catabolism, and by extension improve morbidity and mortality, and end with future directions that have the potential to significantly improve patient care.
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Affiliation(s)
- Carly M Knuth
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Auger
- Department of Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Neniwal V, Sharma R, Meena A. Epidemiological clinical profile and outcome of electric burn at our tertiary care center in Hadoti region. INDIAN JOURNAL OF BURNS 2021. [DOI: 10.4103/ijb.ijb_20_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Peñaranda CF, Acon D, Valdes CA, Wu L. Bilateral maculopathy and cataracts secondary to an accidental high-voltage electrical discharge. Taiwan J Ophthalmol 2020; 11:187-189. [PMID: 34295627 PMCID: PMC8259525 DOI: 10.4103/tjo.tjo_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/20/2020] [Indexed: 11/07/2022] Open
Abstract
The aim of the study was to describe the ocular findings following an accidental high-voltage electrical discharge. A 32-year-old male suffered an accidental electric discharge of 10,000 volts of direct current. He developed cortical, nuclear, and posterior subcapsular opacities in both the eyes. The retinal examination showed bilateral macular cysts. Four months after the event, the macular cyst in the OD spontaneously regressed without visual improvement. The macular cyst in the OS remained unchanged. High-voltage electrical discharge can lead to bilateral maculopathy and cataracts. The visual prognosis is reserved. The visual acuity may not improve despite macular cyst regression.
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Affiliation(s)
| | - Dhariana Acon
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa RIca, San José, Costa Rica, USA.,Illinois Eye and Ear Infirmary, Univerity of Illinois, Chicago, Illinois, USA
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Ding H, Huang M, Li D, Lin Y, Qian W. Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China. J Int Med Res 2019; 48:300060519891325. [PMID: 31854209 PMCID: PMC7782948 DOI: 10.1177/0300060519891325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the epidemiological profile and associated outcomes of electrical injuries at a major burn centre in southern China. METHODS This retrospective study enrolled consecutive electrical burn patients admitted to the burn centre of the First Affiliated Hospital of Guangxi Medical University between 2008 and 2017. Demographic and clinical data and outcomes were recorded. Mann-Whitney U tests/Pearson's chi-squared tests were used to examine the differences between low-voltage and high-voltage injuries. RESULTS There were 217 high-voltage injuries and 159 low-voltage injuries. High-voltage burns were frequently observed between March and August, and low-voltage burns peaked between June and September. Burn patients were mainly men. Most burns occurred in participants aged 21 to 50 years and in industrial workers and electricians at work or householders at home. Only one person with high-voltage burns died (a mortality rate of 0.46%). Amputation rates were 37.33% for high-voltage burns and 22.01% for low-voltage burns. High-voltage injuries were associated with more extensive burns, longer hospital stays, and more complications and amputations. CONCLUSIONS More attention should be paid to prevention of electrical burns in male adults. Particular focus is needed on industrial workers, incidents in the spring and summer, and high-voltage injuries.
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Affiliation(s)
- Huarong Ding
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meimei Huang
- Department of Plastic and Aesthetic Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dehui Li
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuan Lin
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res 2018; 38:e293-e298. [PMID: 27359191 PMCID: PMC5179293 DOI: 10.1097/bcr.0000000000000373] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aims of this article are to review low-voltage vs high-voltage electrical burn complications in adults and to identify novel areas that are not recognized to improve outcomes. An extensive literature search on electrical burn injuries was performed using OVID MEDLINE, PubMed, and EMBASE databases from 1946 to 2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. Fourty-four percent of these patients were low-voltage injuries (LVIs), 38.3% high-voltage injuries (HVIs), and 43.7% with voltage not otherwise specified. Forty-four percentage of studies did not characterize outcomes according to LHIs vs HVIs. Reported outcomes include surgical, medical, posttraumatic, and others (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI than in LVI. Only two studies report on psychological outcomes such as posttraumatic stress disorder. Mortality rates from electrical injuries are 2.6% in LVI, 5.2% in HVI, and 3.7% in not otherwise specified. Coroner's reports revealed a ratio of 2.4:1 for deaths caused by LVI compared with HVI. HVIs lead to greater morbidity and mortality than LVIs. However, the results of the coroner's reports suggest that immediate mortality from LVI may be underestimated. Furthermore, on the basis of this analysis, we conclude that the majority of studies report electrical injury outcomes; however, the majority of them do not analyze complications by low vs high voltage and often lack long-term psychological and rehabilitation outcomes after electrical injury indicating that a variety of central aspects are not being evaluated or assessed.
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Affiliation(s)
- Jessica G Shih
- From the *Division of Plastic Surgery, Department of Surgery and †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‡Department of Immunology, University of Toronto, Ontario, Canada; and §Sunnybrook Research Institute, Toronto, Ontario, Canada
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Hsieh CH, Sudario-Lumague R, Yang JS, Lin CC, Hsu SY. Analysis of electrical injury in a Level I southern Taiwan trauma center. FORMOSAN JOURNAL OF SURGERY 2018. [DOI: 10.4103/fjs.fjs_60_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ranjan R, Manayath GJ, Dsouza P, Narendran V. Spontaneous anatomical and functional recovery of bilateral electric shock maculopathy. Indian J Ophthalmol 2017; 65:1256-1261. [PMID: 29133672 PMCID: PMC5700614 DOI: 10.4103/ijo.ijo_536_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 12-year-old boy presented with best-corrected visual acuity (BCVA) of 6/9 in both eyes following an episode of electric shock. Optical coherence tomography (OCT) showed disruption of the ellipsoid zone as well as retinal pigment epithelium (RPE) layer. Fundus autofluorescence (FAF) showed increased central hypoautofluorescence in both eyes. At 3-month follow-up, BCVA improved to 6/6 with OCT showing spontaneous resolution of maculopathy in both eyes with reorganized RPE layer and ellipsoid zone. To the best of our knowledge, this is the first case of bilateral electric shock maculopathy (ESM) with spontaneous anatomical as well as functional recovery. Ophthalmologists must be aware of various forms of ESM. OCT and FAF must be done in patients presenting with defective vision and history of electric shock for the diagnostic as well as prognostic evaluation.
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Affiliation(s)
- Ratnesh Ranjan
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - George Joseph Manayath
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Palmeera Dsouza
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Venkatapathy Narendran
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Abstract
Although uncommon, electrical injuries are associated with significant morbidity and mortality. There have been several reports of neurological sequelae secondary to electrical injury; however, the neurophysiology is still not completely understood. These neurological complications pose the greatest risk for permanent disability. We present a case of acute-onset quadriplegia after high-voltage electrical injury without radiographic evidence. Two months after the injury, the patient went on to regain partial sensorimotor function. Only a few case reports in the literature exist describing neurological recovery after electrical burn-induced quadriplegia. These cases are reviewed.
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Electrical burns in times of economic crisis: A new epidemiologic profile. Burns 2016; 42:1861-1866. [DOI: 10.1016/j.burns.2016.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/22/2022]
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Mene A, Biswas G, Parashar A, Bhattacharya A. Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study. World J Crit Care Med 2016; 5:228-234. [PMID: 27896147 PMCID: PMC5109921 DOI: 10.5492/wjccm.v5.i4.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/19/2016] [Accepted: 08/06/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To 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. METHODS A 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. RESULTS On 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. CONCLUSION High-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.
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Brûlures par flash électrique, à propos de 33 cas. Une étude rétrospective sur 10ans. Épidémiologie, traitement et prévention. ANN CHIR PLAST ESTH 2015; 60:123-30. [DOI: 10.1016/j.anplas.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/17/2014] [Indexed: 11/24/2022]
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Tarim A, Ezer A. Electrical burn is still a major risk factor for amputations. Burns 2013; 39:354-7. [DOI: 10.1016/j.burns.2012.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 06/17/2012] [Accepted: 06/18/2012] [Indexed: 11/12/2022]
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Abstract
The improved short and long term survival rate of individuals with large burn injuries has made rehabilitation for optimal recovery of the patient increasingly important. Burn injury to the hands worsens the prospect of functional recovery and good quality of life in single events, especially when included in larger burns. The purpose of this paper is to present a narrative review of examination strategies used for children with burn injuries to the hands in the acute, intermediate and long term stages of rehabilitation, and apply these concepts to selected treatments, using a case that is representative of this complex patient population. The model of health described by the World Health Organisation provided the framework for the review, to structure the review in the domains of body structures and body functions, functional activities and participation in life roles. The lack of consensus in the burn literature regarding the most appropriate outcome measures and interventions necessitates futures research and long term outcome studies to identify, predict and prevent the difficulties patients may face over their lifespan.
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Affiliation(s)
- April C Cowan
- Shriners Hospital for Children, Department of Rehabilitation Services, 815 Market St, Galveston, TX 77550, United States.
| | - Caroline W Stegink-Jansen
- University of Texas Medical Branch, School of Health Professions, Department of Physical Therapy, 301 University Boulevard, Galveston, TX 77555-1144, United States
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Lumenta DB, Vierhapper MF, Kamolz LP, Keck M, Frey M. Train surfing and other high voltage trauma: differences in injury-related mechanisms and operative outcomes after fasciotomy, amputation and soft-tissue coverage. Burns 2011; 37:1427-34. [PMID: 21852047 DOI: 10.1016/j.burns.2011.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the context of scarce reports on train surfers among high voltage electric injuries, we conducted a retrospective review between January 1994 and December 2008. METHODS After matching for inclusion criteria we reviewed patient records of 37 true high voltage injuries (12 train surfers [TS] and 25 other high voltage injuries [HV]). RESULTS TS were significantly younger (TS 15.8 years vs. HV 33.3 years, p<0.0001), and had a greater %TBSA (TS 49.7%TBSA vs. HV 21.5%TBSA, p=0.0003) without affecting the median length-of-stay (TS 52 days vs. HV 49 days) or number of operations (TS 4 vs. HV 3). TS had different injury patterns, with a higher percentage of affected extremities (TS 72.9% vs. HV 52.0%, p=0.0468) and associated injuries (TS 58% vs. HV 20%, n.s.) than HV. Both groups demonstrated comparable fasciotomy (TS 71.4% vs. HV 55.8%) and amputation rates (TS 17.1% vs. HV 15.4%). While TS required less flaps (TS 3/12 vs. HV 18/25; p=0.0153), soft-tissue reconstruction revealed an overall low incidence of complication rates (one partial pedicled flap loss and two total free flap losses). CONCLUSIONS Train surfers have proven to be a distinct group of patients among high-voltage injuries notably as a result of a younger age, a shorter electric contact duration and higher velocity-induced trauma. With a possibly declining trend of train surfing-related accidents in an aging society, it will be interesting to see if emerging economies will face comparable phenomena, for which prevention strategies remain key.
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Affiliation(s)
- David Benjamin Lumenta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Abstract
Accidental electrocution during working activities account for a considerable amount of morbidity and mortality. Workers often misjudge the danger of electric wires or high-tension power cables, thereby exposing themselves to electrocution hazard. This article describes a nonfatal case of injuries by arcing from high-tension power-line cables involving a young farmer who was thrashing an olive tree by means of aluminum ladder. The circumstances surrounding the manner of electrocution and the features of electric injuries are presented and discussed.
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Lee GK, Suh KJ, Kang IW, Hwang DH, Min SJ, Han YM, Choi MH. MR imaging findings of high-voltage electrical burns in the upper extremities: correlation with angiographic findings. Acta Radiol 2011; 52:198-203. [PMID: 21498349 DOI: 10.1258/ar.2010.100326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND A high-voltage electrical burn is often associated with deep muscle injuries. Hidden, undetected deep muscle injuries have a tendency for progressive tissue necrosis, and this can lead to major amputations or sepsis. MRI has excellent soft tissue contrast and it may aid in differentiating the areas of viable deep muscle from the areas of non-viable deep muscle. PURPOSE To describe the MR imaging findings of a high-voltage electrical burn in the upper extremity with emphasis on the usefulness of the gadolinium-enhanced MRI and to compare the MR imaging findings with angiography. MATERIAL AND METHODS We retrospectively reviewed the imaging studies of six patients with high-voltage electrical burns who underwent both MRI and angiography at the burn center of our hospital from January 2005 to December 2009. The imaging features were evaluated for the involved locations, the MR signal intensity of the affected muscles, the MR enhancement pattern, the involved arteries and the angiographic findings (classified as normal, sluggish flow, stenosis or occlusion) of the angiography of the upper extremity. We assessed the relationship between the MR imaging findings and the angiographic findings. RESULTS The signal intensities of affected muscles were isointense or of slightly high signal intensity as compared with the adjacent unaffected skeletal muscle on the T1-weighted MR images. Affected muscles showed heterogenous high signal intensity relative to the adjacent unaffected skeletal muscle on the T2-weighted images. The gadolinium-enhanced T1-weighted images showed diffuse inhomogeneous enhancement or peripheral rim enhancement of the affected muscles. The angiographic findings of the arterial injuries showed complete occlusion in three patients, severe stenosis in two patients and sluggish flow in one patient. Of these, the five patients with complete occlusion or severe stenosis on angiography showed non-perfused and non-viable areas of edematous muscle on MRI. On the other hand, one patient with sluggish flow on angiography showed a perfused and viable area of edematous muscle on MRI. CONCLUSION Gadolinium-enhanced MRI is a useful non-invasive imaging modality to detect the site and extent of hidden, undetected deep muscle injuries in a group of patients with high-voltage electrical burns of the upper extremities.
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Affiliation(s)
- Gyung Kyu Lee
- Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul
| | - Kyung Jin Suh
- Department of Radiology, Dongguk University College of Medicine, Gyeongju Hospital, Gyeongju
| | - Ik Won Kang
- Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul
| | - Dae Hyun Hwang
- Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul
| | - Seon Jung Min
- Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul
| | - You Mie Han
- Department of Radiology, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul
| | - Min Ho Choi
- Department of Internal Medicine, Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul, Republic of Korea
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Orak M, Ustündağ M, Güloğlu C, Gökhan S, Alyan O. Relation between serum Pro-Brain natriuretic peptide, myoglobin, CK levels and morbidity and mortality in high voltage electrical injuries. Intern Med 2010; 49:2439-43. [PMID: 21088345 DOI: 10.2169/internalmedicine.49.3454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage. METHODS In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels. RESULTS When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001). CONCLUSION Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.
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Affiliation(s)
- Murat Orak
- Emergency Department, University of Dicle, Diyarbakir, Turkey.
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Abstract
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.
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Abstract
Traumatic panniculitis refers to changes in the subcutaneous fat related to physical or chemical agents. The clinical picture of traumatic panniculitis is nonspecific. Cutaneous lesions are indurated, warm, red, subcutaneous plaques or nodules not necessary related to the intensity of the injury. The histologic picture includes fat microcysts surrounded by histiocytes, collections of foam cells, and inflammatory cells. Late lesions may show fibrosis, lipomembranous changes, or dystrophic calcic deposits. Traumatic panniculitis is usually a self-limiting disorder and requires only symptomatic treatment.
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Abstract
Physiatrists play a critical role in managing the medical and functional consequences of serious burn injuries. Goals of rehabilitation include wound healing, scar prevention, hypertrophic scarring suppression, full range of motion, strengthening, and independent mobility and activities of daily living. This article is an overview of burn rehabilitation principles and patient management. The ultimate rehabilitation goal is independence in all spheres of an individual's life. Achievement of independence depends on the commitment of the injured individual and the entire health care team.
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Abstract
Burn injuries result in significant physical and psychologic complications that require comprehensive rehabilitation treatment and coordination with the acute care burn team. This interdisciplinary rehabilitation treatment is focused on preventing long-term problems with scarring, contractures, and other problems that limit physical function. Adequate pain management and recognition of psychologic issues are important components of treatment after burn injuries. Burn injuries present significant barriers to community integration, but many people can successfully return to work and other activities.
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Affiliation(s)
- Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Affiliation(s)
- Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Abstract
Although the management of the severely burnt extremity poses a significant therapeutic dilemma, burn injuries resulting in amputation are uncommon, In such cases, however, amputation can reduce the rate of mortality. In a total of 1858 patients from January 1980 to January 2004, there were 34 amputations in 27 patients. There were 23 men (age range, 14-64 years) and 4 women (age range, 34-85 years). The majority of amputations from burns caused by flame injury predominantly after motor vehicle accidents, with only eight cases resulting from high-voltage electrical injury. Nine patients required immediate amputations, with the rest being delayed. There were three deaths, with a survival rate of 89%. The majority of single lower-limb amputees and only one of seven bilateral amputees were independently mobile. The presence of pre-existing psychiatric disease significantly impaired rehabilitation. Free tissue transfer and the usage of bioengineered materials may help reduce the incidence of amputations.
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Affiliation(s)
- Peter J Kennedy
- NSW Severe Burn Injury Service, Concord Hospital, Sydney, Australia
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Windhofer C, Gruber S, Hofer E, Papp C. Free flap survival despite severe anemia after fourth degree hand burn. Burns 2006; 32:261-5. [PMID: 16451819 DOI: 10.1016/j.burns.2005.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Affiliation(s)
- C Windhofer
- Department of Plastic and Reconstructive Surgery, Hospital Barmherzige Brüder, Salzburg, Austria.
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Kesiktas E, Dalay C, Ozerdem G, Acarturk S. Reconstruction of deep cubital fossa defects with exposure of brachial artery due to high tension electrical burns and treatment algorithm. Burns 2005; 31:629-36. [PMID: 15993307 DOI: 10.1016/j.burns.2005.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Erol Kesiktas
- Department of Plastic, Reconstructive and Easthetic Surgery, Cukurova University, Hospital of Balcali, 01330 Adana, Turkey.
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Avşaroğullari L, Sözüer E, Ikizceli I, Kekeç Z, Yürümez Y, Ozkan S. Adult burn injuries in an Emergency Department in Central Anatolia, Turkey: a 5-year analysis. Burns 2003; 29:571-7. [PMID: 12927982 DOI: 10.1016/s0305-4179(03)00140-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Burn injuries require a multidisciplinary approach. Emergency Departments can play vital roles in the treatment of burns. The purpose of this study is to investigate the epidemiological and clinical characteristics of the adult burn patients admitted to our Emergency Department and to determine the frequency of the patients who were treated on an outpatient basis and discharged from the Emergency Department. PROCEDURE A retrospective review of 314 adult burn patients who presented to the Emergency Medicine Department of Erciyes University Hospital from January 1996 to December 2000. FINDINGS Sixty-four percent of the patients were male. Mean age was 32.9+/-14.7. Ninety-nine patients (32%) had moderate to major burns. The highest numbers of patients were in the 21-30 age group. Flame burns comprised the majority of presentations and admissions (48 and 69%, respectively). Thirteen patients had associated injuries (4%). Eighty-seven patients (28%) were hospitalized, 21 of these died. Death occurred mostly from respiratory failure and sepsis. Domestic accidents were the leading mechanism (63%). CONCLUSION Burns were mostly due to accidents arising from carelessness, ignorance, hazardous traditions and improperly manufactured products. These can be prevented through mass education programs countrywide. Because almost all burn patients present to Emergency Departments first and not all hospitals can employ burn specialists, the patients with minor burns can be treated on an outpatient basis and the treatment of severe burns can be effectively initiated by emergency physicians.
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Affiliation(s)
- Levent Avşaroğullari
- Department of Emergency Medicine, Medical School of Erciyes University, Kayseri, Turkey.
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Bariar LM, Ahmad I, Aggarwal A, Menon RK. Myelopathy following high voltage electrical injury: a case report. Burns 2002; 28:699-700. [PMID: 12417170 DOI: 10.1016/s0305-4179(01)00125-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L M Bariar
- Unit of Plastic Surgery, Department of Surgery, J.N. Medical College, Aligarh Muslim University, 202002, UP, Aligarh, India.
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Abstract
Although the incidence of electrical burns is not very high this incidence is rising in India. The residual effects of electrical burns are sometimes very severe and long lasting, if not managed properly. This case report is of a patient who sustained severe electrical burns over his left arm, lower abdomen and perineal area. The injuries were so severe that life-saving disarticulation of the limb together with excision of the involved pubic bone and genitalia and suprapubic urinary diversion was done. During follow up an unusual finding was noticed. There was a peritubal leak with no drainage from the catheter and on removal of the catheter, a manual examination of the urinary bladder revealed a stone which was removed at the same time. Following removal of the stone two ureteric openings with the trigone were seen and it was concluded that the granulating tissue was actually the posterior wall of the bladder. This was then mobilized and reposited into the abdomen. The deficient lower abdomen was reconstructed with a tensor fascia lata flap. A penile reconstruction for the patient is under consideration.
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Affiliation(s)
- S P Bajaj
- Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital, New Delhi, India
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