Application of digital subtraction angiography and type B ultrasonography in the evaluation of vascular injury in patients with high voltage electrical injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To compare the difference between digital subtraction angiography (DSA) and type B ultrasonography in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.</p><p><b>METHODS</b>Nineteen patients with high voltage electrical injury of upper limbs were enrolled in the study as burn group, and another 12 healthy volunteers as controls. The endovascular membrane, vascular wall thickness, intra-vascular blood flow and endovascular thrombosis formation of ulnar and radial arteries at wound site and in regions 5, 10 and 15 cm proximal to the wounds were examined by DSA and type B ultrasonography and compared with imagings of healthy volunteers as control. The injury degree of the ulnar and radial arteries was examined during operation for evaluation to corroborate with DSA and ultrasonography findings. Necrotic and/or thrombotic vessels were excised and sent for pathomorphological examination.</p><p><b>RESULTS</b>By DSA images abnormal signs as thrombosis, vascular lumen stenosis and blood flow deceleration were found in 14 ulnar and 11 radial arteries, and the signs were more pronounced in ulnar arteries. By type B ultrasonography, abnormal signs as roughing of tunica intima, swelling or exfoliation, thickening of vascular wall, lumen stenosis, decreased blood flow, even necrosis of vascular wall and thrombosis were identified in 19 ulnar and 16 radial arteries in burn group (P < 0.05 approximately 0.01). The blood flow in ulnar artery 5 cm to the approximal part of the wound edge was obvious lower than that of the control (31.60 +/- 13.90 ml/min vs 47.70 +/- 9.60 ml/min, P < 0.05).</p><p><b>CONCLUSION</b>Type B ultrasonography and DSA could be helpful in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.</p>

The application of ultrasonography to estimate blood vessel injury of upper limbs sustaining electric burns / 中华外科杂志

<p><b>OBJECTIVE</b>To explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns.</p><p><b>METHODS</b>Eighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control.</p><p><b>RESULTS</b>B ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound.</p><p><b>CONCLUSIONS</b>The ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.</p>

The application of ultrasonography in the diagnosis of deep electric injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the application of ultrasonography in the diagnosis of deep electric injury.</p><p><b>METHODS</b>HP-IPHX high resolution color and pulse doppler ultrasonography was employed in the study. The hemodynamic indices were determined in the burn wound area and tissues 5 - 15 cm proximal to the wound in 12 patients with deep electric injury. At the same time, injuries to subcutaneous and muscular tissue and blood vessels (fifty-six blood vessels detected) were detected.</p><p><b>RESULTS</b>1. It was found by two-dimentional ultrasonography that the injury degree in different tissue after deep electric injury was different, i.e. blood vessels were most liable to injury followed by muscles and subcutaneous tissue. In the burn wound area, endothelium was not visualized in 7 blood vessels and endothelial swelling was identified in 12 blood vessels. Furthermore, vascular occlusion was found in 4 blood vessels and thrombosis found in 5 vessels. 2. It was also demonstrated by color ultrasonography that change in course of blood vessel and tortuesity were observed in 12 blood vessels, stenosis of lumen in 21 vessels and widened intravascular space in 11 vessels, All these findings were confirmed in the subsequent operations. 3. It was revealed by pulse Doppler that the top blood flow speed increased during vascular contraction period in narrowed blood vessels with decreased blood flow per minute.</p><p><b>CONCLUSION</b>Being an non-invasive examination, ultrasonography could directly demonstrate the morphological changes in subcutaneous tissue, muscle and blood vessels after a deep electric injury, which might help determine the injury degree and the hemodynamic changes in the injured site.</p>