Queimadura elétrica: Análise epidemiológica dos pacientes da Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia / Electrical burns: Epidemiological analysis of patients at the Burns Unit of the Hospital de Clínicas of the Federal University of Uberlândia

Introdução: O uso da corrente elétrica é imprescindível nas nossas atividades do cotidiano, porém, seu contato com tecidos vivos pode provocar queimaduras desde leves até graves ou fatais. Por se tratar de um problema de saúde pública, o conhecimento de sua epidemiologia é essencial para o desenvolvimento de programas em saúde. Método: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura elétrica na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia entre os anos de 2013 e 2019. Resultados: Foram admitidos 26 pacientes, a maioria de sexo masculino (76,9%) e adultos (30,7%), vítimas de corrente de alta voltagem (65,4%) no trabalho (57,7%), que mais afetou as extremidades superiores (80,7%), sendo as crianças todas do sexo feminino (15,3%). O percentual médio de área queimada foi de 14,5% e o percentual de tratados com autoenxerto de pele foi de 53,8%. A média de permanência hospitalar foi de 40 dias e 3,8% deles foram para a Unidade de Terapia Intensiva. Não se registraram óbitos durante o período. Conclusão: A incidência de pacientes atendidos por queimadura elétrica é baixa, acometendo vítimas em todas as faixas etárias e com predomínio em indivíduos adultos do sexo masculino em seu local de trabalho. O tratamento cirúrgico mais realizado foi o autoenxerto de pele. As políticas de promoção, prevenção e proteção em saúde no que diz respeito aos perigos da corrente elétricas não estariam sendo praticadas e difundidas em nossa população doméstica, laboral ou empregadora, diferentemente como ocorre em grande parte dos países desenvolvidos.

Introduction: Using electric current is essential in our daily activities; however, its contact with living tissue can cause mild to severe or fatal burns. As it is a public health problem, knowledge of its epidemiology is essential for the development of health programs. Method: Cross-sectional study of data recorded in the medical records of patients treated for electrical burns at the Burns Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia between 2013 and 2019. Results: 26 patients were admitted, the majority of whom were male (76 .9%) and adults (30.7%), victims of high voltage current (65.4%) at work (57.7%), which most affected the upper extremities (80.7%), with children all female (15.3%). The average percentage of burned area was 14. 5% and the % of those treated with skin autograft was 53.8%. The average hospital stay was 40 days, and 3.8% went to the Intensive Care Unit. No deaths were recorded during the period. Conclusion: The incidence of patients treated for electrical burns is low, affecting victims in all age groups and with a predominance of adult males in their workplace. The most common surgical treatment was skin autograft. Health promotion, prevention, and protection policies regarding the dangers of electrical currents would not be practiced and disseminated among our domestic, working, or employing population, unlike what occurs in most developed countries.

Epidemiological analyses of 480 patients with electrical burn complicated by cerebral trauma / 中华创伤杂志

Objective:To explore the epidemiological characteristics of patients with electrical burn at different voltages complicated by cerebral trauma, so as to provide a basis for improving the treatment level of such injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 480 patients with electrical burn complicated by cerebral trauma treated in Qingdao Municipal Hospital affiliated to Qingdao University from January 2001 to December 2019. According to the voltage intensity, the patients were divided into low voltage group (injury voltage<1 kV, n=295) and high voltage group (injury voltage≥1 kV, n=185). Gender, age, status of burn and other general data of all patients were collected. The clinical manifestations, consciousness [Glasgow coma scale (GCS)], imaging findings, treatment, prognosis [Glasgow outcome scale (GOS)] and complications were compared between the two groups. Results:(1) Gender and age: the male to female ratio was 5.4∶1.0; the peak age of onset occurred at 18-60 years, accounting for 302 patients (62.9%); the status of burn: the burn area ranged from 1%-78% [(20.0±4.0)%] total body surface area (TBSA), with the current outlet located at the head in 321 patients. (2) Clinical manifestations: consciousness disorders accounted for the highest proportion, with 295 patients (100%) in low voltage group and 185 patients (100%) in high voltage group, followed by headache which occurred in 178 patients (60.3%) in low voltage group and 115 patients (62.2%) in high voltage group (all P>0.05). (3) Consciousness: 37 patients presented coma, with 17 patients (5.8%) in low voltage group and 20 patients (10.8%) in high voltage group ( P<0.05). (4) Imaging findings: CT and MRI examination found cerebral edema, skull fracture, intracranial hematoma, cerebral ischemia, subarachnoid hemorrhage, and other positive lesions. In patients with head wounds (current inlet and outlet located in the head), the incidence of cerebral trauma was 44.0% in low voltage group and 86.8% in high voltage group ( P<0.05). In patients with no head wound (the current outlet was not located in the head), the incidence of cerebral trauma was 5.3% in low voltage group and 6.3% in high voltage group ( P>0.05). In contrast with the patients without current outlet locating in the head, there were three more types of cerebral trauma in patients with current outlet locating in the head, including skull fracture, intracranial hematoma and subarachnoid hemorrhage. (5) Treatment, prognosis and complications: 478 patients (99.6%) received non-surgical treatment and 2 patients (0.4%) received surgical treatment. There was 1 death (0.2%) and 479 successfully treated patients (99.8%). The prognosis was good in 280 patients (94.9%), moderately disabled in 13(4.4%) and severely disabled in 2(0.7%) in low voltage group; while the prognosis was good in 143 patients (77.3%), moderately disabled in 30(16.2%), severely disabled in 11(5.9%) and death in 1(0.5%) in high voltage group (all P<0.01). After discharge, the incidence of numbness, paresthesia and anxiety was significantly higher in low voltage group than that in high voltage group (all P<0.01). Conclusions:Male patients with electrical burn complicated by cerebral trauma are more than female patients, with the young and middle-aged population being at high risk. Disturbance of consciousness and headache are the main clinical manifestations. The incidence of high voltage coma is relatively higher. Compared with low voltage-induced electrical burn, the patients with high voltage-induced electrical burn complicated by cerebral trauma (current inlet and outlet located at the head) sustain more severe and extensive injury. Early and active CT or MRI examination is conducive to definite diagnosis. Non-surgical treatment is the main treatment. Compared with high voltage-induced electrical burn, the patients with low voltage-induced electrical burn complicated by cerebral trauma have significantly better prognosis, but are more likely to develop complications of numbness, paresthesia and anxiety.

Imunomodulação em paciente queimado fasciotomizado: Relato de caso / Immunomodulation in a burned fasciotomized patient: A case report

OBJETIVO: Descrever a evolução clínica e nutricional de paciente queimado fasciotomizado com uso de terapia nutricional imunomoduladora. RELATO DO CASO: Estudo do tipo relato de caso, realizado durante 52 dias na Unidade de Tratamento de Queimados do Hospital da Restauração Governador Paulo Guerra, em Recife-PE. Paciente do sexo masculino, adulto, 27 anos, proveniente do interior de Pernambuco, sem comorbidades, queimado por eletricidade de alta voltagem após acidente de trabalho, evoluindo com síndrome compartimental do membro superior esquerdo e submetido a fasciotomia. Prescrita dieta por via oral associada à suplementação imunomoduladora de característica hipercalórica, hiperproteica, contendo arginina e alto teor de oligoelementos e micronutrientes. Durante o internamento, o paciente apresentou manutenção do estado nutricional, com adesão de novos hábitos alimentares que contribuíram para a cicatrização do membro afetado. CONCLUSÃO: A terapia nutricional imunomoduladora individualizada beneficiou a reparação tecidual, cicatrização e redução do risco de amputação em paciente queimado fasciotomizado.

OBJECTIVE: To describe the clinical and nutritional evolution of a burn patient submitted to fasciotomy and immunomodulating nutritional therapy. CASE REPORT: A case-report study was conducted over a 52-day period at the Burn Treatment Unit of Governador Paulo Guerra Restauração Hospital in the city of Recife, Brazil. A 27-year-old male patient, brown skin color, from the instate region of the state of Pernambuco, without comorbidities, suffered a high-voltage electrical burn after a work accident, developing compartment syndrome of the left upper limb, and was submitted to fasciotomy. An orally diet was prescribed associated with immunomodulatory supplementation with a hypercaloric, hyper protein character, with arginine and high content of trace elements and micronutrients. During hospitalization, the patient's nutritional status was maintained with the adherence to new dietary habits, which contributed to the healing of the affected limb. CONCLUSIONS: Individualized immunomodulating nutritional therapy benefits the tissue repair and healing processes, reducing the risk of amputation in burn patients submitted to fasciotomy.

Research advances in diagnosis and treatment of high-voltage electric burn of the wrist / 中华创伤杂志

High-voltage electric burn is a special type of burns with high mortality and disabilities and is concerned by the public. High-voltage electric burn of the wrist is characterized by severe injury, difficulty in determining the degree of injury, complicated treatment process and poor prognosis, bring a huge burden to the society and family. In recent years, imaging examination has provided a more reliable basis for the diagnosis and classification of high-voltage electric burn. The development of microsurgery technology has also given more options for wound repair. The authors review epidemiology, clinical type, injury diagnosis and surgical treatment of wrist high-voltage electric burn, so as to provide references for clinical diagnosis and treatment of high-voltage electric burn of the wrist.

Terapia por pressão negativa em lesões por queimadura elétrica no paciente pediátrico / Negative pressure therapy in injuries for electrical burns in pediatric patients

OBJETIVOS: Relatar o uso da Terapia por Pressão Negativa (TPN) em um paciente pediátrico vítima de queimadura elétrica e fornecer subsídios fundamentais para o melhor tratamento, possibilitando, assim, que outros pacientes se beneficiem com esta terapêutica. MÉTODO: Trata-se de um relato de caso único que avaliou o uso da TPN em um paciente pediátrico. Os dados foram coletados por meio das anotações do prontuário eletrônico do paciente. RESULTADOS: Pode-se considerar que a conduta inicial de uma equipe multidisciplinar foi fundamental para o prognóstico do paciente. Além disso, o membro superior direito acometido pela queimadura elétrica apresentou resultados satisfatórios e significativos quando instituída a TPN. CONCLUSÃO: O relato de caso revelou que a TPN foi imprescindível para a recuperação da lesão do paciente pediátrico, sendo uma alternativa confortável para crianças vítimas de queimaduras, além de permitir a aderência das enxertias de pele e a cicatrização mais rápida das lesões.

OBJECTIVES: To report the use of Negative Pressure Therapy (NPT) in a pediatric patient suffering from electric burn and provide fundamental subsidies for the best treatment, thus allowing other patients to benefit from this therapy. METHODS: This is a single case report that evaluated the use of NPT in a pediatric patient. The data were collected through the patients electronic medical records. RESULTS: The initial management of a multidisciplinary team could be considered as fundamental for the patients prognosis. In addition, the right upper limb affected by electric burn presented satisfactory and significant results when NPT was instituted. CONCLUSION: The case report revealed that NPT was essential for recovery of the pediatric patients lesion, being a comfortable alternative for children who are victims of burns, besides allowing the adhesion of the skin grafts and the faster healing of the lesions.

Queimaduras ocupacionais no Distrito Federal, Brasil: Estudo retrospectivo de 17 anos / Work-related burns in the Federal District, Brazil: A 17-year retrospective study

OBJETIVO: Avaliar a epidemiologia das queimaduras ocupacionais e as características sociodemográficas das vítimas de queimaduras internadas em um hospital público no período de 17 anos. MÉTODO: Estudo longitudinal, retrospectivo de abordagem quantitativa realizado na unidade de queimados de um hospital público no Brasil de janeiro de 2002 a dezembro de 2018. Entre 4201 queimados internados nesse período, 497 foram vítimas de queimaduras no ambiente de trabalho e tiveram seus prontuários médicos e de alta hospitalar avaliados retrospectivamente. RESULTADOS: A maioria dos pacientes era do sexo masculino (88,5%) e a média de idade foi de 35 anos (intervalo, 18-74). As causas mais frequentes de queimaduras foram eletricidade (41,1%), líquidos inflamáveis (27,5%) e chamas (11,7%). As ocupações mais comuns foram: eletricista (25,3%), cozinheiro (10,9%) e mecânico (8,2%). A superfície corporal queimada média foi de 15,4% e a taxa de mortalidade foi de 2,6%. Variações anuais foram observadas na frequência mensal de acidentes de trabalho, com aumento do número de queimaduras em maio e novembro, que são meses que precedem festividades culturais no Brasil. CONCLUSÃO: Poucas mudanças na epidemiologia e gravidade das queimaduras ocupacionais foram observadas no período de 17 anos de estudo, sugerindo que os programas de prevenção não foram eficazes na redução de queimaduras no ambiente de trabalho. Assim, novas iniciativas dos setores público e privado são necessárias, visando a prevenção de queimaduras de trabalho.

OBJECTIVE: To evaluate the epidemiology of work-related burns and sociodemographic characteristics of burn victims admitted to a public hospital over a period of 17 years. METHODS: This longitudinal, retrospective, quantitative study was conducted in the burn unit of a public hospital in Brazil from January 2002 to December 2018. Of the 4201 burn patients admitted to the hospital during the study period, 497 of them were victims of work-related burns, and therefore their hospital discharge summary and medical records were retrospectively reviewed. RESULTS: Most patients were men (88.5%) and the mean age was 35 years (range, 18-74). Electricity was the most frequent cause of burns (41.1%), followed by flammable liquids (27.5%) and flames (11.7%). The most common occupations were electricians (25.3%), cooks (10.9%), and mechanics (8.2%). The mean total body surface area involved was 15.4% and the mortality rate was 2.6%. Annual periodic variations were observed in the monthly frequency of work-related burns, with an increased number of burn accidents occurring in May and November, which are months that precede cultural festivities in Brazil. CONCLUSIONS: Few changes in the epidemiology and severity of work-related burns were observed during the 17-year study period, suggesting that prevention programs have not been effective in reducing burn accidents in the workplace. Thus, new initiatives from the public and private sectors aiming at preventing work-related burn injuries are necessary.

Application of low temperature thermoplastic plate combined with special abdominal band in fixing abdominal pedicled flap for repairing 17 patients with deep electric burn wounds in hands / 中华烧伤杂志

If the abdominal pedicled flaps are not well fixed after repair of deep electric burn wounds in hands, many problems such as poor blood supply may occur. In order to solve the above problems, we designed and manufactured the individualized low temperature thermoplastic plate combined with special abdominal band to fix abdominal pedicled flaps for repairing of 17 patients (12 males and 5 females, aged 2-35 years) with deep electric burn wounds in hands from February 2016 to August 2018, and achieved the desired results. The shoulder joint, elbow joint, and wrist joint were fixed by low temperature thermoplastic plate according to the 1/2 circumference of the patient′s side chest and upper arm, and the braking of wrist joint and elbow joint was strengthened by special abdominal band. Application of the combined method of fixing abdominal pedicled flaps in repairing deep electric burn wounds in hands has high success rate of flap transplantation. It is simple to make and practical, and worthy of clinical promotion.

Clinical application of lobulated transplantation of free anterolateral thigh perforator flap in the treatment of electric burns of limbs / 中华烧伤杂志

Objective@#To explore the clinical efficacy of lobulated transplantation of free anterolateral thigh perforator flap in repairing electric burn wounds of limbs.@*Methods@#From August 2014 to April 2019, 19 patients with electric burns in the limbs were hospitalized in our unit, including 18 males and 1 female, aged 20-58 years. There were 37 wounds deep to bone. The area of wounds ranged from 3.0 cm×2.0 cm to 40.0 cm×8.0 cm. Multiple-perforator-based anterolateral thigh flap was designed and resected. Then the flap was lobulated taking the respective perforators of the lateral circumflex femoral artery as the axial vessels before being transplanted to the debrided wounds in the limbs. The blood vessel trunk or the perforator vessels of flap lobes were anastomosed with the respective vessels in the recipient sites. The wounds were repaired with respective lobes of the flap when repairing multiple wounds in one surgical procedure, whereas the lobes were spliced or staggered to cover the wound to fit the shape of wound when repairing a single irregular wound in one surgical procedure. For the limb with distal blood supply disorder, the blood supply branch of flap was used to reconstruct the blood supply. If necessary, an appropriate length of vein was taken for transplantation. The improvement of reconstructed blood supply was observed. The number of surgeries, the number of anterolateral thigh perforator flaps, the number and size of flap lobes, the number of anastomosed vessels in each surgery, the treatment of the donor sites, the length of each surgery, the postoperative complications and survival condition of flap lobes were recorded. The upper extremity function was evaluated with the Carroll′s Upper Extremity Function Test Scale, and the patients′ satisfaction degree with the therapeutic effect of each surgery was investigated with a 5-point Likert Scale during follow-up. Surgeries were divided into single wound group of repairing one wound at one time and multiple wounds group of repairing two or more wounds at one time. The number of anastomosed vessels in each surgery, the treatment of the donor sites, the length of each surgery, and the postoperative survival condition of the flap lobes were compared between the two groups. Surgeries were divided into early group of performing surgery within post burn day 7 and late group of performing surgery on post burn day 7 and beyond. The postoperative complications and survival condition of flap lobes, the evaluation score of upper limb function and the patients′ satisfaction degree with the therapeutic effect of each surgery at the last follow-up were compared between the two groups. Data were processed with independent sample t test, Mann-Whitney U test, or Fisher′s exact probability test.@*Results@#The blood supply of 5 patients with distal hand or finger blood supply disorder recovered or improved significantly after vascular transplantation. A total of 46 lobes [(2.2±0.4) lobes per flap] were obtained from 21 anterolateral thigh perforator flaps in 19 patients with 21 surgeries. The area of flap lobes ranged from 4.0 cm×3.0 cm to 24.0 cm×13.0 cm. In each surgery, 2.0 (1.5, 3.0) arteries and 3.0 (2.0, 3.0) veins were anastomosed. Six donor sites were repaired by thin split-thickness scalp, and 15 donor sites were closed directly. The duration of each surgery was (8.9±1.7) h. After surgery, bleeding and hematoma occurred in 2 flap lobes and local infection occurred in 5 flap lobes, which were improved after management. Vascular crisis occurred in 4 flap lobes, and exploratory surgeries were performed, after which 2 lobes survived, while the other 2 lobes necrotized and were repaired by other methods. The rest flap lobes survived well. After each postoperative follow-up of 3 to 60 months, the flap covering areas of the limbs were well-recovered. At the last follow-up, the function evaluation score of 20 affected upper limbs was 85 (63, 90) points, and the score of patients′ satisfaction degree with the therapeutic effect of each surgery was (4.4±0.7) points. A total of 30 flap lobes were obtained in 14 surgeries and repaired 30 wounds respectively in multiple wounds group, and 16 flap lobes were obtained in 7 surgeries and were spliced to repair 7 large irregular wounds in single wound group. There were no statistically significant differences in the number of anastomosed artery or vein in each surgery, and the duration of each surgery between multiple wounds group and single wound group (Z=0.240, 0.081, t=0.180, P>0.05), and the condition of skin grafting in the donor sites and the postoperative survival of the flap lobes in multiple wounds group were similar to those in single wound group (P>0.05). A total of 22 flap lobes were obtained in 10 surgeries and repaired 18 wounds in early group, and 24 flap lobes were obtained in 11 surgeries and repaired 19 wounds in late group. The incidence of postoperative hematoma, infection, vascular crisis, and survival of flap lobes in early group were similar to those in late group (P>0.05). There were no statistically significant differences in the patients′ satisfaction degree with the therapeutic effect of each surgery at the last follow-up between early group and late group (t=0.701, P>0.05). At the last follow-up, the function evaluation score of 9 upper limbs in early group was 90 (85, 97) points, significantly higher than 80 (40, 85) points of 11 upper limbs in late group (Z=2.431, P<0.05).@*Conclusions@#Free lobulated anterolateral thigh perforator flap is suitable for simultaneous repair of multiple electric burn wounds of limbs, as well as the repair of a single large irregular wound. It has the clinical advantages of less damage to the donor site and good repair quality. The early flap transplantation is beneficial to improve the function of limbs with electric burns.

Clinical characteristics and repair effect of 136 patients with electric burns of upper limb / 中华烧伤杂志

Objective@#To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns.@*Methods@#Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test.@*Results@#(1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ2=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01).@*Conclusions@#Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

Limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation / 中华烧伤杂志

Objective@#To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation.@*Methods@#From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded.@*Results@#All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function.@*Conclusions@#Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

Strengthen standardized diagnosis and treatment to improve the prognosis of electric burn / 中华烧伤杂志

Because of the complex injury mechanism, hidden tissue injury, and severe systemic injury, the clinical diagnosis and treatment of electric burn still face many challenges, and the mortality and disability rate are still high. In view of the particularity of electric burn and the prognosis of electric burn, especially the quality of wound repair, the author puts forward some personal views on fluid resuscitation, organ protection, and wound repair on the basis of summarizing the new methods of diagnosis and treatment of electric burn at home and abroad at present, and preliminarily explores the standardized diagnosis and treatment of electric burn.

Transplantation of compound tissue flap of toe to reconstruct the thumb with necrosis caused by electric burns in four patients / 中华烧伤杂志

From January 2010 to December 2017, 4 patients of thumb with necrosis caused by electric burns (all male, aged from 31 to 58 years) were admitted to our hospital, with 1 patient of second degree injury of right thumb, 2 patients of third degree injury of right thumb, and 1 patient of third degree injury of left thumb. Routine debridement under general anesthesia was performed within 7 days after injury. The compound tissue flap of contralateral second toe was transplanted to reconstruct the thumb with third degree defect, and compound tissue flap of ipsilateral distal hallex was transplanted to reconstruct the thumb with second degree defect. Dorsalis pedics artery was anastomosed with radial artery, saphenous vein or dorsalis pedics vein was anastomosed with cephalic vein. The donor site was transplanted with split-thickness skin graft from autologous thigh. All the tissue flaps and skin grafts survived in 2 weeks after surgery. Within 1 year of follow-up, the reconstructed thumbs can achieve radial abduction and palmar abduction with good function. Reconstruction of thumb with free transplantation of compound tissue flap of toe is a good method to repair thumb with necrosis caused by electric burn.

Reconstrucción de miembro superior posterior a lesión catastrófica por quemadura / Upper extremity reconstruction after a catastrophic injury from burning

INTRODUCCIÓN. Las lesiones catastróficas del miembro superior han sido lesiones devastadoras que afectaron a muchas estructuras esenciales como la mano, antebrazo, brazo y órganos adyacentes, que casi siempre conducen a una incapacidad significativa, de forma directa o mediante el impacto psicosocial que se relacione con la ausencia o atrofia de miembros. OBJETIVO. Demostrar la versatilidad y efectividad del uso del colgajo paraescapular para cubrir defectos severos postraumáticos en un miembro superior catastrófico. Así como, dar a conocer resultados de una amputación digital que preserve la mayor funcionalidad de la mano. CASO CLINICO. Paciente masculino de 37 años, que sufrió quemadura eléctrica de alto voltaje de tercer grado del 30,0% de superficie corporal total. Se realizó tratamiento con colgajo paraescapular para defecto axilar y amputación digital funcional en manos. RESULTADOS. Al quinto mes postquirúrgico se evidenció todos los movimientos conservados en la extremidad superior sin retracción a nivel axilar. Tras la rehabilitación se consiguió conservar en las manos gran porcentaje de fuerza prensil y motricidad fina. DISCUSIÓN. El colgajo paraescapular permitió una reconstrucción temprana y definitiva del defecto extenso, mejorando la funcionalidad de la extremidad superior derecha. La amputación digital preservó una máxima longitud funcional, permitiendo una curación rápida de las heridas, disminuyendo costos y estancia hospitalaria. CONCLUSIÓN. El colgajo paraescapular brindó cobertura a defectos de hombro y axila que permitió recuperar todos los ángulos de movilidad de la extremidad afectada, sin retracción de la piel. La amputación funcional de rayos en la mano admitió conservar fuerza prensil y motora, mejorando la calidad de vida.

INTRODUCTION. Catastrophic injuries of the upper limb have been devastating injuries that affected many essential structures such as the hand, forearm, arm and adjacent organs, which almost always lead to a significant disability, directly or through the psychosocial impact that is related to the absence or atrophy of members. OBJECTIVE. Prove the versatility and effectiveness of the use of the paraescapular flap to cover severe post-traumatic defects in a catastrophic upper limb. As well as, present results of a digital amputation that preserves the greatest functionality of the hand. CLINICAL CASE. A 37 year old male patient, who suffered a third degree high voltage electrical burn of 30,0% of total body surface area. Treatment was performed with paracapular flap for axillary defect and functional digital amputation in hands. RESULTS. By the fifth postoperative month, all movements preserved in the upper extremity without retraction at the axillary level were evident. After the rehabilitation it was possible to keep in the hands a great percentage of prehensile strength and fine motor skills. DISCUSSION. The paraescapular flap allowed an early and definitive reconstruction of the extensive defect, improving the functionality of the right upper extremity. The digital amputation preserved a maximum functional length, allowing a quick healing of the wounds, reducing costs and hospital stay. CONCLUSION. The paraescapular flap provided coverage for shoulder and axilla defects, which allowed recovery of all the angles of mobility of the affected limb, without retraction of the skin. The functional amputation of rays in the hand allowed conserving prehensile and motor strength, improving the quality of life.

Effects of ultrathin abdomen flap on repairing deep electric burn wounds in finger of pediatric patients / 中华烧伤杂志

Objective@#To investigate the effects of ultrathin abdomen flap in repairing deep electric burn wounds in finger of pediatric patients.@*Methods@#A total of 14 pediatric patients with simple electric burns in finger were admitted to our unit from March 2013 to October 2017. Six patients had electric burns in one finger, 5 patients had electric burns in two fingers, and 3 patients had electric burns in three fingers. The size of wounds in single finger ranged from 2.0 cm×1.0 cm to 3.5 cm×2.0 cm. After complete preoperative examination, wounds debridement and ultrathin abdomen flap repair operation were performed on 3 to 6 days post injury. Six pediatric patients were treated with abdominal random flap, 4 patients were treated with inferior epigastric artery paraumbilical perforator bilobed flap, and the other 4 patients were treated with superficial circumflex iliac artery bilobed flap. The size of flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×4.0 cm. The donor sites were sutured directly.@*Results@#The flaps of 14 pediatric patients survived well after operation, and no flap showed blood supplying disorder. During follow-up of 3 to 24 months, the appearance and function of fingers were good, and the donor sites recovered well, with no cicatrix contracture deformity.@*Conclusions@#The ultrathin abdomen flap is one of the good choices for repairing deep electric burn wounds in finger of pediatric patients.

Effects of anteriolateral thigh perforator flap and fascia lata transplantation in combination with computed tomography angiography on repair of electrical burn wounds of head with skull exposure and necrosis / 中华烧伤杂志

Objective@#To explore the effects of anteriolateral thigh perforator flap and fascia lata transplantation in combination with computed tomography angiography (CTA) on repair of electrical burn wounds of head with skull exposure and necrosis.@*Methods@#Seven patients with head electrical burns accompanied by skull exposure and necrosis were admitted to our burn center from March 2016 to December 2017. Head CTA was performed before the operation. The diameters of the facial artery and vein or the superficial temporal artery and vein were measured, and their locations were marked on the body surface. Preoperative CTA for flap donor sites in lower extremities were also performed to track the descending branch of the lateral circumflex femoral artery with the similar diameter as the recipient vessels on the head, and their locations were marked on the body surface. Routine wound debridement and skull drilling were performed successively. The size of the wounds after debridement ranged from 12 cm×8 cm to 20 cm×12 cm, and the areas of skull exposure ranged from 8 cm×6 cm to 15 cm×10 cm. Anteriolateral thigh perforator flaps with areas from 13 cm×9 cm to 21 cm×13 cm containing 5-10 cm long vascular pedicles were designed and dissected accordingly. The fascia lata under the flap with area from 5 cm×2 cm to 10 cm×3 cm was dissected according to the length of vascular pedicle. The fascia lata was transplanted to cover the exposed skull, and the anteriolateral thigh perforator flap was transplanted afterwards. The descending branch of the lateral circumflex femoral artery and its accompanying vein of the flap were anastomosed with superficial temporal artery and vein or facial artery and vein before the suture of flap. The flap donor sites were covered by intermediate split-thickness skin graft collected from contralateral thigh or abdomen.@*Results@#The descending branch of the lateral circumflex femoral artery and its accompanying vein were anastomosed with superficial temporal artery and vein in six patients, while those with facial artery and vein in one patient. All the flaps survived after the operation, and no vascular crisis was observed. Wound healing was satisfactory. One patient was lost to follow up. Six patients were followed up for 6 to 10 months. The patients were bald in the head operation area with acceptable appearance. No psychiatric symptom such as headache or epileptic seizure was reported. The flap donor sites were normal in appearance. The muscle strength of the lower extremities all reached grade V. The sensation and movement of the lower extremities were normal.@*Conclusions@#Anterolateral thigh perforator flap with fascia lata transplantation can effectively repair electrical burn wounds of head with skull exposure and necrosis. The fascia lata can be used to protect the vascular pedicle of flaps, which is beneficial to the survival of the flap. Preoperative head and lower extremities CTA can provide reference for intraoperative vascular exploration in donor site and recipient area, so as to shorten operation time.

Wound repair and functional reconstruction of high-voltage electrical burns / 中华烧伤杂志

In the repair of burn wound, high-voltage electrical burn wound is still the most complicated and the most difficult one to deal with. According to the clinical experience of author and the literature at home and abroad, this article systematically discusses the early treatment of high-voltage electrical burn wounds, including limbs escharotomy, fasciotomy, and early debridement, and the repair of high-voltage electrical burn wounds in various parts, especially in some special parts, focusing on the repair of the life-threatening parts and site of large vascular injury. At the same time, this article discusses the feasibility and necessity of functional reconstruction. We should make full use of modern repair technology and innovation, interdisciplinary cooperation, so as to reduce disability rate, amputation rate, and mortality of patients with high-voltage electrical burns as far as possible.

Clinical application of computed tomography angiography and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps / 中华烧伤杂志

Objective@#To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps.@*Methods@#From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh.@*Results@#During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer.@*Conclusions@#CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.

Analysis of microRNA expression profile in serum of patients with electrical burn or thermal burn / 中华烧伤杂志

Objective@#To explore the differential expression of microRNAs in the serum among patients with electrical burn or thermal burn and healthy persons and to explore the significance.@*Methods@#In this study we included three patients with electrical burn and three patients with thermal burn, conforming to the inclusion criteria and hospitalized in our burn ward from June to August 2015, and three healthy adult volunteers. Their serum samples were separated from whole blood and divided into electrical burn group, thermal burn group, and normal control group. Total RNA was extracted from their serum samples using Trizol method. The differentially expressed microRNAs (with differential ratio larger than or equal to 2.000, less than or equal to 0.500) among the three groups were screened by microRNA chip technique. Then cluster and Venn diagram analysis of the differentially expressed microRNAs were performed. Enrichment analysis of Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway was performed on the distinctly changed microRNAs (with differential ratio larger than or equal to 5.000, less than or equal to 0.500).@*Results@#There were 220 differentially expressed microRNAs among serum of the three groups. MicroRNA expression profiles in serum of electrical burn and thermal burn groups were different from that in serum of normal control group. Compared with those in serum of normal control group, the expressions of 59 microRNAs changed more than 2.000 times in serum of electrical burn group, with 50 up-regulated microRNAs and 9 down-regulated microRNAs; the expressions of 40 microRNAs changed more than 2.000 times in serum of thermal burn group, with 21 up-regulated microRNAs and 19 down-regulated microRNAs. Compared with those in serum of thermal burn group, the expressions of 167 microRNAs changed more than 2.000 times in serum of electrical burn group. There were 17 exclusively expressed microRNAs in serum of thermal burn group and 26 exclusively expressed microRNAs in serum of electrical burn group, compared with those in serum of normal control group. Enrichment analysis of KEGG signaling pathway showed that compared with those in serum of normal control group, microRNAs which changed distinctly in serum of electrical burn group took part in the insulin secretion signaling pathway, arrhythmogenic right ventricular cardiomyopathy signaling pathway, hypertrophic cardiomyopathy signaling pathway, glutamatergic synapse signaling pathway, calcium signaling pathway, cyclic adenosine monophosphate signaling pathway, glycerophospholipid metabolism, pyrimidine metabolism, serotonergic synapse signaling pathway, etc, while microRNAs which changed distinctly in serum of thermal burn group took part in the tumor transcription misregulation signaling pathway, proteoglycans in tumor signaling pathway, microRNAs in tumor signaling pathway, long-term potentiation signaling pathway, citrate cycle signaling pathway, tumor necrosis factor signaling pathway, focal adhesion signaling pathway, endocytosis signaling pathway, insulin secretion signaling pathway, p53 signaling pathway, and estrogen signaling pathway, etc.@*Conclusions@#MicroRNA expression profiles in serum of electrical and thermal burn are different from that in serum of healthy adult. The signaling pathways enriched with target genes which are regulated by the differentially expressed microRNAs are related to the pathological changes and clinical manifestations after electrical or thermal burn.

Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage / 中华烧伤杂志

Objective@#To analyze the features of magnetic resonance imaging (MRI) of patients with high-voltage electrical burns in limbs at early stage.@*Methods@#Thirty-eight patients with high-voltage electrical burns, conforming to the study criteria, were hospitalized in our unit from March 2013 to August 2016. T1 weighted imaging (T1WI), T2WI, fat-suppression T2WI plain scan, and fat-suppression T1WI enhanced scan of MRI were performed in 78 limbs, including 56 upper limbs and 22 lower limbs at post injury hour 72. The MRI signal characteristics of electrical burns in skin and subcutaneous tissue, skeletal muscle, tendon, joint ligament, and skeleton of limbs were analyzed. " Sandwich-like" necrosis and injury in skeletal muscle, injuries of tendon, joint ligament, and skeleton were observed. MRI signal characteristics of amputated upper limbs and salvaged limbs were also analyzed. All patients underwent surgery within 24 h after MRI examination, and the muscle vitality was judged during operation. Muscle tissue without reaction to electrical stimulation which was completely necrotic as shown by MRI, muscle tissue with weak reaction to electrical stimulation which was injured with blood supply as shown by MRI, and muscle tissue with edema as shown by MRI were collected, and then the pathological characteristics of muscle tissue were observed with HE staining.@*Results@#(1) The defect area of patients at entrance of current was bigger than that at exit. The skin and subcutaneous tissue extensively unevenly thickened. T2WI manifested hyperintensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested uneven enhancement. Zonal effusion was seen in the region of serious subcutaneous edema. (2) For complete necrosis of skeletal muscle, T2WI manifested hypointense, isointensity, or slight hyperintensity, and T1WI manifested isointensity, slight hyperintensity, or mixed signal of isointensity and slight hyperintensity, while fat-suppression enhanced T1WI manifested most no enhancement area with clear boundary. The MRI signals of injured skeletal muscle could be divided into two types. Type Ⅰ signal was for partial necrotic muscle adjacent to the completely necrotic zone. T2WI manifested uneven hyperintensity or slight hyperintensity, with unclear boundary. T1WI manifested isointensity or slight hyperintensity. Fat-suppression enhanced T1WI manifested significant banding or laciness enhancement. Type Ⅱ signal was for deep muscle tissue far from the complete necrotic zone. T2WI manifested hyperintensity, and T1WI manifested isointensity or main isointensity mixed with hyperintensity, while fat-suppression enhanced T1WI manifested uneven moderate or slight enhancement. Normal muscle signal, type Ⅰ signal, and type Ⅱ signal were all mixed with necrotic signal, showing " sandwich-like" change. For skeletal muscle edema, T2WI manifested slight hyperintensity and unclear boundary, and T1WI manifested hypointense, while fat-suppression enhanced T1WI manifested no obvious enhancement. (3) For complete necrosis of tendon, T2WI manifested isointensity or slight hyperintensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested no enhancement. For tendon injury, T2WI manifested isointensity, and T1WI manifested isointensity or hypointense, while fat-suppression enhanced T1WI manifested slight enhancement. (4) Severe injury of wrist joint were manifested as complete necrosis of soft tissue around joint. T2WI manifested slight hyperintensity or isointensity, and T1WI manifested isointensity, while fat-suppression enhanced T1WI manifested no enhancement or slightly uneven enhancement. For completely destroyed wrist joints, the structures were not clear from outside to inside. T2WI manifested slight hyperintensity or isointensity, and T1WI manifested hypointense or isointensity, while fat-suppression enhanced T1WI manifested no enhancement. For elbow injury, T2WI manifested hyperintensity, and T1WI manifested isointensity or hypointense, while fat-suppression enhanced T1WI manifested uneven enhancement. For knee injury, T2WI manifested hyperintensity, and T1WI manifested hypointense, while fat-suppression enhanced T1WI manifested slight enhancement. (5) For bone edema, T2WI manifested isointensity, while fat-suppression T2WI manifested slight hyperintensity. T1WI manifested isointensity, and fat-suppression enhanced T1WI manifested patchy enhancement. (6) MRI of amputated upper limbs showed necrosis signals, type Ⅰ signals, type Ⅱ signals, and mixed signals of type Ⅰ and type Ⅱ in skeletal muscle. The necrosis signal and type Ⅰ signal area of the distal end were more than 50% greater than those of the lesion. The scope of the ecological tissue was large and the boundary was not clear. There were diffuse injuries in both anterior and posterior muscles, and the ulnar and radial artery pulsation disappeared in the upper limbs. The MRI of salvaged limbs were type Ⅰ signal, type Ⅱ signal, mixed signals of type Ⅰ and type Ⅱ, and local necrosis signals of skeletal muscle. The type Ⅰ signal was the main type, and the distal end showed type Ⅱ signal. (7) For completely necrotic skeletal muscle as shown by MRI, surgical exploration showed loss of muscle viability, and pathological examination showed complete necrosis of striated muscle tissue. For injury area of skeletal muscle as shown by MRI, surgical exploration showed interecological muscle with activity worse than mormal muscle, and pathological examination showed normal muscle cells and muscle fiber mixed with necrotic striated muscle cells having karyopyknosis, with different degree of injury. For edema area of skeletal muscle as shown by MRI, surgical exploration showed swelling skeletal muscle and normal muscle vitality, and pathological examination showed striated muscle interstitial edema with a large number of inflammatory cells infiltration. The manifestions of MRI were consistent with the results of surgical exploration and pathological examination.@*Conclusions@#Skeletal muscle complete necrosis, injury, and edema could be preferably differentiated by MRI, and the definite scope and depth of electrical injury, the injury of skin, tendon, joint ligament, and bone could also be displayed well on MRI. It can provide objective imaging basis for the diagnosis of high-voltage electrical burns in limbs at early stage, the establishment of clinical operation plan, and the judgment of intraoperative tissue vitality.

Changes of platelet rheological behavior and the interventional effects of ulinastatin in rats with high-voltage electrical burns / 中华烧伤杂志

Objective@#To explore the influence of high-voltage electrical burns on the number of platelet aggregation, β-thromboglobulin (β-TG) and platelet factor 4 (PF-4) and the interventional effects of ulinastatin in rats with high-voltage electrical burns.@*Methods@#A total of 240 Sprague-Dawley rats were divided into sham injury (SI) group, simple electrical burn (SEB) group, normal saline (NS) group, and ulinastatin (UTI) group according to the random number table, with 60 rats in each group. The electrical current was applied to the outside proximal part of left forelimb of rats and exited from the outside proximal part of right hind limb of rats. Rats in groups SEB, NS, and UTI were inflicted with high-voltage electrical burn wounds of 1 cm×1 cm at current entrances and exits, with the voltage regulator and experimental transformer. Rats in group SI were sham injured through connecting the same equipments without electricity. At 2 min post injury, rats in group NS were intraperitoneally injected with 2 mL/kg NS, and rats in group UTI were intraperitoneally injected with 2×104 U/kg UTI of 10 g/L. At 15 min before injury and 5 min, 1 h, 2 h, 4 h, 8 h post injury, 10 rats in each group were selected to collect 5-7 mL blood of heart respectively. Blood of 0.05 mL were collected to make fresh blood smear for observing the number of platelet aggregation, and serum were separated from the remaining blood to determine content of β-TG and PF-4 with enzyme-linked immunosorbent assay. Data were processed with analysis of factorial design of variance, student-Newman-Keuls test, Kruskal-Wallis H test, Wilcoxon rank sum test, and Bonferroni correction.@*Results@#(1) At 15 min before injury, the numbers of platelet aggregation of rats were close among groups SI, SEB, NS and UTI (5.9±1.2, 5.8±1.2, 5.9±1.3, 5.9±1.1, respectively, with P values above 0.05). At 5 min, 1 h, 2 h, 4 h, 8 h post injury, the numbers of platelet aggregation of rats in group SEB were 57.2±16.3, 59.1±16.9, 60.8±20.6, 83.6±24.9, and 83.4±30.3, respectively, obviously more than those in group SI (6.0±1.3, 6.0±1.4, 5.9±1.4, 5.7±1.1, and 5.8±1.3, respectively, with P values below 0.001); the numbers of platelet aggregation of rats in group UTI were 29.6±7.4, 31.9±10.1, 35.0±14.2, 43.0±13.6, and 35.2±11.1, respectively, obviously more than those in group NS (58.3±16.1, 63.9±18.0, 60.8±17.7, 74.2±23.0, and 82.3±21.9, respectively, with P values below 0.001). There was no significantly statistical difference in the number of platelet aggregation of rats in group SI between each two time points within the same group (with P values above 0.05), but the number of platelet aggregation of rats in the other 3 groups at each time point post injury was significantly more than that of the same group at 15 min before injury (with P values below 0.001). (2) At 2, 4, and 8 h post injury, β-TG content of serum of rats in group SEB was significantly higher than that in group SI (with Z values from -3.780 to -3.477, P values below 0.05). At 5 min and 4 h post injury, β-TG content of serum of rats in group UTI was significantly lower than that in group NS (with Z values respectively -3.477 and -3.780, P values below 0.05). There was no significantly statistical difference in β-TG content of serum of rats in group SI at all time points of the same group (χ2=0.130, P >0.05). At 2, 4, and 8 h post injury, β-TG content of serum of rats in group SEB was significantly higher than that of the same group at 15 min before injury (with Z values from -3.780 to -3.553, P values below 0.05). At 5 min, 1 h, and 4 h post injury, β-TG content of serum of rats in group NS was significantly higher than that of the same group at 15 min before injury (with Z values from -3.780 to -3.477, P values below 0.05). At 1 and 4 h post injury, β-TG content of serum of rats in group UTI was significantly higher than that of the same group at 15 min before injury (with Z values respectively -3.250 and -3.780, P values below 0.05). (3) At 2 and 8 h post injury, PF-4 content of serum of rats in group SEB was significantly higher than that in group SI (with P values below 0.05). At 2 h post injury, PF-4 content of serum of rats in group UTI was significantly higher than that in group NS (P<0.05), and at 4 and 8 h post injury, PF-4 content of serum of rats in group UTI was significantly lower than that in group NS (with P values below 0.05). At all time points, PF-4 content of serum of rats in group SI was close (with P values above 0.05). At 2 and 8 h post injury, PF-4 content of serum of rats in group SEB was significantly higher than that of the same group at 15 min before injury (with P values below 0.05). At 1, 4, and 8 h post injury, PF-4 content of serum of rats in group NS was significantly higher than that of the same group at 15 min before injury (with P values below 0.05). There were significantly statistical differences in PF-4 content of serum of rats between all time points except for 5 min post injury and 15 min before injury (with P values below 0.05).@*Conclusions@#Increasing number of platelet aggregation and abnormal secretion of β-TG and PF-4 of rats with high-voltage electrical burns can lead to microcirculation disturbance. UTI can alleviate microcirculation disturbance caused by high-voltage electrical burns by reducing the number of platelet aggregation and inhibiting secretion of β-TG and PF-4.