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@#A 22-year-old male who came in contact with a high-voltage wire, with entry point at the head and exit points at the ankles, presented with flaccid paraplegia and loss of sensation of bilateral lower extremities with no radiographic abnormalities. Several burn-related medical complications arose during the admission, as well as episodes of demotivation. Bilateral below the knee amputation was done because of extensive burn injuries of the lower extremities. The rehabilitation management for a patient with multiple disabilities needed to be tailored depending on the limitations and needs of the patient at a certain point in time. Despite the challenges, satisfactory results were achieved, through telerehabilitation and employing a multidisciplinary team approach.
Subject(s)
Spinal Cord Injuries , Amputation, SurgicalABSTRACT
Resumen Introducción: La disminución de la fracción de eyección ventricular izquierda (FEVI) como consecuencia de una disfunción ventricular se reporta dentro de las alteraciones cardiacas secundarias a una lesión eléctrica. Como complemento de la exploración física, la ecografía cardiaca enfocada (FoCUS) permite una evaluación rápida, no invasiva, que da información para contribuir a tomar mejores decisiones terapéuticas, sobre todo en pacientes en estado crítico. El objetivo de este estudio fue explorar la utilidad de la creatina fosfocinasa MB (CPK-MB) como marcador diagnóstico de disfunción miocárdica en pacientes de 6 a 18 años con quemadura eléctrica. Métodos: Durante el periodo de noviembre de 2018 a agosto de 2019 se llevó a cabo un estudio transversal analítico de 10 pacientes, de 6 a 18 años de edad, con quemadura eléctrica, en quienes se obtuvo el porcentaje de FEVI a través del protocolo FoCUS. Posteriormente, el porcentaje de FEVI se correlacionó con los valores de CPK-MB y el porcentaje de superficie corporal quemada (SCQ) en las primeras 24 horas después de la lesión. Resultados: Se encontraron 10 casos de quemadura eléctrica, ocho de sexo masculino y dos de sexo femenino, con una media de edad de 13 años. El 80% de estos casos presentó disminución leve de la FEVI (45-59%). Al realizar el protocolo FoCUS se reportó hipocinesia miocárdica en siete pacientes. Se encontró una correlación moderada entre la FEVI y los valores de CPK-MB (r = −0.671), aunque no se observó correlación entre la FEVI y la SCQ. Conclusiones: La ecografía cardiaca influye en la toma de decisiones y mejora el pronóstico de estos pacientes.
Abstract Background: The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods: From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results: We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = −0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions: The cardiac ultrasound influences decision making to improve the prognosis of these patients.
Subject(s)
Adolescent , Child , Humans , Burns, Electric , Ventricular Dysfunction, Left , Creatine Kinase, MB Form , Burns, Electric/complications , Burns, Electric/diagnosis , Burns, Electric/metabolism , Ventricular Dysfunction, Left/etiology , Creatine Kinase, MB Form/analysisABSTRACT
Subject(s)
Humans , Arteries , Burns , Foot , Foreign Bodies , Free Tissue Flaps , Hair , Hand , Skin , Transplants , Wounds and InjuriesABSTRACT
Low voltage electric shock resulting in myocarditis induced delayed death is a rarity and has not been reported so far, to the best of our knowledge. The definitive diagnosis is autopsy based as it has variable clinical presentations. We report such a case where in the histopathologic findings of myocarditis came as a surprise during microscopic evaluation of the autopsy sections in a case with an apparently normal heart on gross examination. The present case mandates a careful microscopic examination of autopsy sections in cases of electrocution.
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Objective To investigate the therapeutic effect of hydrogen-rich saline on the rheological behavior of leukocytes in mesentery capillary of rats with high-voltage electrical burn .Methods 180 rats were randomly divided into four groups :burn injury plus normal saline group ,burn injury plus hydrogen-rich saline group ,sham plus normal saline group ,and burn injury plus papaver-ine group .The rats were received saline ,hydrogen-rich saline ,saline ,papaverine at different time points after scald respectively .The changes of rheological behavior of leukocytes in mesentery capillary of rats before and after the injury were investigated .Results The rheological behavior of leukocytes in mesentery capillary of the control group were observed no significant change (P>0 .05) . In experimental group the rolling white blood cell count ,the number of leukocyte adhesion ,the length of contact of leukocyte-endo-thelial cell at each phase after injury were higher than those at 15 min before injury (P<0 .05);leukocyte rolling speed after injury is lower than that before injury (P<0 .05) .In treatment group and positive control group ,the rolling white blood cell count ,the number of leukocyte adhesion ,the length of contact of leukocyte-endothelial cell at each phase after injury were higher than those at 15 min before injury (P<0 .05) ,but compared with the experimental group ,the increase range was lower (P<0 .05) .leukocyte rolling speed after injury is lower than that before injury (P<0 .05) ,and compared with the experimental group ,the reduction was lower (P<0 .05) .Conclusion The hydrogen-rich brine can effectively reduce the changes of rheological behavior of leukocytes in mesentery capillary of rats caused by high-voltage electrical burn ,and have a protective effect on rat mesenteric .
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Amputation stump pains can be developed in amputation sites after high voltage electrical burn injuries. We experienced one case of these severe stump pains in an upper extremity amputation patient. A 35-year-old man had a 38% total body surface area high voltage electrical burn. The patient underwent skin grafting and left shoulder disarticulation. During the rehabilitation period, he complained about severe stump area pains and phantom pains. We injected 0.5% Bupivacaine and Triamcinolone on the stump neuroma site but the pain sustained. After extracorporeal shock wave therapy (ESWT,) the pain subsided and did not recur. The patient was satisfied with functional and pain outcomes, so we report this case.
Subject(s)
Adult , Humans , Amputation, Surgical , Amputation Stumps , Body Surface Area , Bupivacaine , Burns , Disarticulation , Neuroma , Phantom Limb , Rehabilitation , Shock , Shoulder , Skin Transplantation , Triamcinolone , Upper ExtremityABSTRACT
It is known that cases of osteomyelitis are less common than 5% in deep burn cases. This research presents a case of chronic osteomyelitis, presented 7 years after initial electrical burn injury. A 43-year-old male patient was admitted to the Department of Plastic Surgery, suffering from an 22900-voltage electrical burn on right medial malleolus in 2010. There was no postoperative complication for five years observation. In November 2016, he was admitted to the Plastic Surgery department, suffering from the skin and soft tissue defect on right medial malleolus without trauma history. The osteomyelitis on the right medial malleolus was found in bone scintigraphy. The medial malleolus was covered with a local flap two days after admission. Dehiscence was found after surgery and exudate was emerged continuously from the flap site. We decided to cover the raw surface with a perforator based propeller flap 22 days after admission considering reconstructive ladder. The flap survived successfully, and partial epidermal sloughing was healed completely by daily dressing at 51 days after the surgery. It is advisable to establish and access the prudent plan before surgery through many kinds of radiological tests and physical examinations considering vascular stability and delayed wound healing.
Subject(s)
Adult , Humans , Male , Bandages , Burns , Exudates and Transudates , Osteomyelitis , Physical Examination , Postoperative Complications , Radionuclide Imaging , Skin , Surgery, Plastic , Wound HealingABSTRACT
Objective To investigate the influence of high-voltage electrical burn on the throm-bomodulin (TM), protein C (PC), protein S (PS) and D-Dimer (D-D) in SD rats. Methods One hundred and twenty healthy SD rats were divided into the fake high-voltage electrical burn groups (FHEB), high-voltage electrical burn groups (HEB) according to the random number table, with 60 rats in each group. Ten rats were taken from each group at 15 minutes before injury. Plasma were collected from heart blood. Fifty SD rats of HEB group with voltage regulator and experimental transformer. The remaining fifty SD rats of FHEB group were sham injured with the same devices without electric current. At 5 minutes and 1, 2, 4, 8 hour (s) post injury, 10 rats of every group were randomly chosen at each time point for observation of the concentrations of TM, PC, PS and D-D. Plasma were collected from heart blood. Data were processed with analysis of variance of factorial design and LSD test. Results Compared with the FHEB group, the concentration of TM from 5 minutes to 8 hours post injury in HEB group was higher significantly (P < 0.05). Exception of the concentrations of PC and PS at 15 minutes before injury, the concentrations of PC and PS were lower than those of FHEB group (P < 0.05). The concentration of D-D in HEB group peaked at 8 hours post injury in (173.05 ± 4.08) ng/mL. Conclusion High-voltage electrical burn at early stage can increase the concentrations of TM, D-D, as well as decrease the concentrations of PC and PS, which are not only causing the vascular endothelium damage but also possessing serious effect on the thromboplastin function of SD rats.
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Background: Burn trauma is the common problems seen in emergency in tertiary care centre of Rohilkhand region. So, far there is no published study regarding the magnitude of burn trauma in this area. Aims & Objective: To study the etiology of major burn trauma in Rohilkhand region of Uttar Pradesh. Material and Methods: This retrospective study was carried out on 96 patients admitted in the Department of Surgery, Rohilkhand Medical College & Hospital, Bareilly during the period of 1st January 2010 to 31st December 2012. Results: Among the total of 36 patients (37.5%) from urban area, 16 (16.6%) were males and 20 (20.8%) were females and from rural area 46 (47.9%) were male and 14 (14.6) were female. The most frequent etiological agent was hot liquid (45.8%) followed by flame burns (33.3%), chemical (13.5%) and electrical (7.2%). Out of the total patients, 47 (48.9%) had 1 and 2 degree burn, 32 (33.3%) had 3 degree burn and 17 (17.7%) had mixed burn. Out of the total of 20 patients, who had died 6 were males and 14 were females. Conclusion: The most frequent cause of burn in Rohilkhand region was hot liquid. The mortality rate was higher for females than males.
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BACKGROUND: Electrical injury can cause serious damage to any part of the nervous system. However spinal cord injury by electricity itself rarely develops. If develops, it can be either electrical myelopathy (immediate or delayed), spinal atrophic paralysis and/or amyotrophic lateral sclerosis-like disease. We are going to report the clinical, electrophysiological and radiographic features of electrical myelopathy (immediate or delayed) of 18 patients. METHODS: We retrospectively reviewed the clinical, electrophysiological and radiographic data of patients who were diagnosed as electrical myelopathy. RESULTS: Among 1,306 patients with electrical injury, 18 patients (1.4%) had electrical myelopathy. Fifteen patients (83%) had motor symptoms and 16 patients (89%) had sensory symptoms or signs. It is interesting for seven patients to appear their neurological symptoms or signs with a day after electrical injury. Somatosensory evoked potentials (SEP) which were done in 17 patients showed abnormal central conduction defects in 12 patients (70.5%). Magnetic resonance images (MRI) of spinal cord, however, did not show any abnormalities in all the tested patients (15 patients). CONCLUSIONS: Clinically, electrical myelopathy can cause not only motor but also sensory symptoms or signs. Interestingly, there were several immediate as well as delayed forms of electrical myelopathy In most patients with electrical myelopathy, SEP was a useful method to detect objective abnormalities but MRI was not.
Subject(s)
Humans , Burns , Electricity , Evoked Potentials, Somatosensory , Magnetic Resonance Imaging , Nervous System , Paralysis , Retrospective Studies , Spinal Cord , Spinal Cord Diseases , Spinal Cord InjuriesABSTRACT
Tipo de Estudio: Descriptivo epidemiológico retrospectivo en 644 pacientes ingresados en la Unidad de quemados del hospital Luis Vernaza período 2003. Objetivos: Ordenar y presentar la información obtenida en el manejo de las quemaduras por electricidad en esta unidad especializada. Resultados: Pacientes de sexo masculino 86.80%, 59.47%, con edades entre 21 y 40 años. El sitio con mayor ocurrencia de accidentes fue el lugar de trabajo con 351 (54.50%) reportes, en el hogar se produjeron 236 (36.65%) casos, 57 (8.85%) en la calle, automóvil, etc. Generalmente los pacientes presentaron quemaduras de II grado con una media de 9.3% de Superficie Corporal Quemada (SCQ). La secuela más importante fue la amputación; 64.3% de éstas se realizaron en miembros superiores. La estancia hospitalaria media fue de 38 días, la mortalidad 3.1%. Conclusiones: La tendencia del número de casos con quemaduras eléctricas atendidos en el hospital Luis Vernaza está elevándose y es importante el grado de discapacidad que producen, lo que puede significar para los sistemas de salud una significativa inversión de recursos.
Type of study: Descriptive, retrospective of 644 patients admitted to the Burn Unit of the Luis Vernaza Hospital period 2003.Objectives: To organize the information obtained in managing electrical burn injuries admitted to the unit.Results:We found that electrical burn injuries were most common in males (86.80%) between the age group of 21-40 (59.47%). Percentage of the most common places of injury was:Place of work 351 (54.50%)Household 236 (36.65%)Street, automobile, etc 57 cases (8.85%)Most of the patients had 2nd degree burns and a mean burn size of 9.3% total body surface area. The most common sequelae were amputation (64.3%) of superior limbs. The mean hospital stay was of 38 days and a mortality of 3.1%.Conclusions: The number of cases of electrical burn injuries admitted at the Hospital Luis Vernaza and rate of disability is increasing.
Subject(s)
Male , Adult , Female , Middle Aged , Accidents, Occupational , Burns, Electric , Burn Units , Fluid Therapy , Occupational RisksABSTRACT
Tetanus is rare in Korea due to the introduction of vaccination programs and the advancement in public health. Its common signs are trismus, voice disturbance, neck stiffness, and difficulty in swallowing, etc. A 56 years old man was injured by grasping a high voltage electric cable. After the accident, he fell down on a steel plate and had a head trauma. When he visited Emergency Department, there was multiple electric burn wound on left arm and left facial area. He was hospitalized on a department of neurosurgery, because intra cranial hemorrhage was presumed. 12 days later, he was referred to department of OMFS with developed painful masseter spasms and trismus. That night he violently bit his tongue with his denture. Because masseter muscle and temporal muscle constriction was involuntary, tongue was lacerated and denture was distorted. At first we supposed that the symptom was related with neurologic disturbance following head trauma or electric shock. But it was revealed that trismus was caused by tetanus on an electrophysiological test. By using mechanical ventilation and administration of tetanus immunoglobulin, muscle-relaxant, and sedatives at ICU, symptoms had subsided (4-weeks). Because tetanus is rare disease, we rarely suppose tetanus infection to be a cause of a trismus. Especially it is more difficult to diagnose in patient who has head trauma, burn and neurologic problem as in this case.
Subject(s)
Humans , Middle Aged , Arm , Burns , Burns, Electric , Constriction , Craniocerebral Trauma , Deglutition , Dentures , Emergency Service, Hospital , Hand Strength , Hemorrhage , Hypnotics and Sedatives , Immunoglobulins , Korea , Masseter Muscle , Neck , Neurosurgery , Public Health , Rare Diseases , Respiration, Artificial , Shock , Steel , Temporal Muscle , Tetanus , Tongue , Trismus , Vaccination , Voice Disorders , Wounds and InjuriesABSTRACT
An electrical burn used to result in the damage of the skin and underlying deep soft tissue injury. Thus, in order to preserve devitalizing tissues and promote the structural survival free flaps with ample blood supply are frequently employed. However, early unpredictable vascular injury and progressive tissue necrosis may cause the free flaps full of hazards. We applied 50 free flaps upon 41 acute electrical burn cases between 1998 and 2004. Injured areas, timing of operation and causes of flap loss were studied. The victim's ages ranged from 13 to 60 years. (an average 37.8 years) Thirteen out of 50 free flaps were lost totally: three cases were due to arterial insufficiency and ten venous congestion. Total loss of flaps were observed in 5 of 12 cases in the postoperative 3 weeks, 6 of 20 cases between 3 and 6 weeks and 2 of 18 cases after 6 weeks. In three of 12 cases the free flap was lost partially in the postoperative 3 weeks, 4 of 20 cases between 3 and 6 weeks and 1 of 18 cases after 6 weeks. The result was statistically significant by a T-test (p<0.05). This study showed that timing of the operation is accountable for the loss of free flap. It is most important to conduct the free flap procedure on an electrical injury at the time when the recipient vessel is definitely discernible and intact so as to minimize the loss of flap and spare the structures.
Subject(s)
Burns , Free Tissue Flaps , Hyperemia , Necrosis , Skin , Soft Tissue Injuries , Vascular System InjuriesABSTRACT
BACKGROUND: The peripheral nerve is known to be vulnerable to electrical injury. However, the character and mechanism of electrical injury to the peripheral nerve is not well established in clinical conditions. METHODS: We retrospectively reviewed the nerve conduction study (NCS) data of patients who had high voltage electrical injury in their upper extremities. RESULTS: Among 16 extremities studied, nine had abnormal NCS findings. Nine of 12 extremities, whose input/output were distal to wrist, showed abnormal NCS findings. In contrast, all four extremities, whose input/output points were their forearm, had normal NCS findings. In the patients who had abnormal NCS findings, the distal portion experienced more severe damage than the proximal portion. CONCLUSIONS: Input/output points are important factors in the electrical injury to the peripheral nerve. Joule heating seems to be a more important mechanism of electrical peripheral nerve injury.
Subject(s)
Humans , Burns , Extremities , Forearm , Heating , Hot Temperature , Neural Conduction , Peripheral Nerve Injuries , Peripheral Nerves , Retrospective Studies , Upper Extremity , WristABSTRACT
PURPOSE: This current study determined the type, incidence, characteristics of ocular complications from electrical burn and associated risk factors. METHODS: The authors retrospectively reviewed ocular complications from electrical injury on ninety-seven consecutive electrical burn patients. RESULTS: Of the ninety-seven patients with electrical burns, twelve patients (12%) had ocular complications (cataract, uveitis, macular hole, corneal opacity, and optic atrophy). The relationship between voltage and development of ocular complication was not statistically significant. The relationship between wound size and development of ocular complication was not significant. However, the relationship between entry site and development of ocular complication was statistically significant (P=0.00). CONCLUSIONS: The patient who had electrical injury at any voltage with any wound size, especially electrical head injury for at least 6 months should be evaluated carefully.
Subject(s)
Humans , Burns , Corneal Opacity , Craniocerebral Trauma , Incidence , Retinal Perforations , Retrospective Studies , Risk Factors , Uveitis , Wounds and InjuriesABSTRACT
We report the delayed sequelae arising in a case of electrical injury, reviewing the literature on the subject and focusing on the MRI findings of the brain. A 23-year-old male suffered burns to the left parietal scalp, both feet, and the anterior chest wall. Neurological symptoms and MRI abnormalities appeared 14 days after the insult and continued for about three months. T1-weighted MR images demonstrated homogeneous hypointensity, while T2-weighted images depicted hyperintense finger-like projections. Contrast-enhanced T1-weighted images demonstrated strong band-like enhancement, indicating meningeal hyperemia. Follow-up MR imaging showed that the lesion had disappeared, indicating that the cerebral edema and meningeal hyperemia were reversible.
Subject(s)
Humans , Male , Young Adult , Brain Edema , Brain , Burns , Follow-Up Studies , Foot , Hyperemia , Magnetic Resonance Imaging , Rabeprazole , Scalp , Thoracic WallABSTRACT
The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, proper treatment method should be applied in order to achive aesthetic and funtioning hand. To reconstruction of soft tissue defect in hand, a variety of treatment have been, but most are associated with drawbacks, such as limited range, limited application, long time surgery, 2nd stage surgery, large donor defect. The reverse dorsal digital and metacarpal island flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks. The series of 15 cases of reconstruction for soft tissue defect due to electrical burn in hand were reviewed. Most cases survived completely and we could gain satisfactory results. Advantages of these flaps are minimal defect in donor site, good reliability, short time and easy technique, versatile variation, usefulness in secondary reconstruction. In conclusion, our result suggested that the reverse dorsal digital and metacarpal artery island flap are very useful methods for reconstruction of soft tissue defect due to electrical burn in hand, functionally and aetheticallly.
Subject(s)
Humans , Arteries , Burns , Hand , Skin , Surgical Flaps , Tissue DonorsABSTRACT
High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.
Subject(s)
Humans , Amputation, Surgical , Blood Vessels , Burns , Debridement , Fibrosis , Foot , Free Tissue Flaps , Incidence , Myocutaneous Flap , Necrosis , Perforator Flap , Retrospective Studies , Saphenous Vein , Skin , Superficial Back Muscles , Survival Rate , Survivors , Tissue Donors , Transplants , VeinsABSTRACT
High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.