Reconstrucción del cuero cabelludo después de una quemadura eléctrica de alto voltaje / Scalp Reconstruction after High-Voltage Electric Burn

Las quemaduras en el cuero cabelludo son raras. Cuando se producen suelen estar causadas por alta tensión eléctrica. La reconstrucción de los defectos del cuero cabelludo por quemaduras eléctricas se hace difícil, en parte por la extensión del defecto y la falta de determinados recursos. Se realizó una técnica con mínimo de secuelas. Se presenta un paciente masculino de 35 años, el cual llega al Cuerpo de Guardia de Caumatología por lesiones por quemaduras eléctricas de alto voltaje. Recibió el tratamiento médico quirúrgico correspondiente, injertos de piel, amputación del tercio distal del pie derecho y el 4to y 5to dedos del pie izquierdo. Solo quedó por resolver el defecto de tejido a nivel de cuero cabelludo. Se realizó rotación de un colgajo con lo cual se logró cubrir casi la totalidad del defecto, completando una pequeña zona con homoinjerto de piel. Se logró un resultado estético adecuado para el paciente con un nivel de satisfacción alto(AU)

Scalp burns are rare. When they occur, they are usually caused by high electrical voltage. The scalp reconstruction for defects caused by electrical burns is difficult, partly because of the defect area and the lack of certain resources. A technique was performed, with minimal sequelae. A 35-year-old male patient is presented with injuries due to high-voltage electricity burns, at the emergency room for caumatology attention. He received the corresponding surgical medical treatment, skin grafts, amputation of the distal third of the right foot and the fourth and fifth fingers of the left foot. Thus pending to solve the tissue defect at the level of the scalp. A flap rotation was performed, based on which almost the entire defect was covered, completing a small area with skin homograft. An adequate aesthetic result was achieved for the patient and with a high level of satisfaction(AU)

Acute Rotator Cuff Tears due to Low Voltage Electrical Injury: A Case Report

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power.

Síndrome compartimental agudo en quemadura eléctrica / Acute compartment syndrome in electric burn

Introducción: El síndrome compartimental agudo es el aumento anormal de la presión en los compartimentos musculares en las primeras horas posteriores a la lesión, generando isquemia, necrosis e, incluso, la muerte de la extremidad afectada. Su tratamiento consiste en la rápida descompresión quirúrgica, con lo cual se preserva la vitalidad de los tejidos. El síndrome compartimental es una entidad poco frecuente en la práctica clínica, y el tratamiento depende de su sospecha y pronto diagnóstico. Métodos: Reportamos el caso clínico de un adulto medio con quemadura eléctrica en miembros superiores, quien durante estancia hospitalaria presentó síndrome compartimental, se realizó el diagnóstico oportuno y fue llevado a fasciotomía temprana con adecuada evolución. Este manuscrito tiene como objetivo realizar una revisión de la literatura e informar al lector sobre los aspectos fundamentales para la sospecha de esta patología. Resultados: Dentro de las características de este síndrome se incluye la disminución de la perfusión tisular, con compresión mecánica del flujo vascular por aumento del contenido en el compartimento y por disminución del continente. El principal síntoma es dolor exagerado con respecto a la lesión, asociado a parestesias, palidez y frialdad. Conclusiones: Además de la limitación en la movilidad de los dedos y la mano, el síntoma principal del síndrome compartimental es el dolor. Un dolor excesivo debe alertarnos siempre y hacernos sospechar un síndrome compartimental. Además, el dolor causado por el estiramiento pasivo de los músculos es un hallazgo clínico más sensible en un síndrome compartimental en desarrollo.(AU)

Introduction Acute compartment syndrome is the abnormal increase of pressure in the muscular compartments in the first hours after the injury, generating ischemia, necrosis and even the death of the affected limb. Its treatment consists in the rapid surgical decompression with which the vitality of the tissues is preserved. The compartment syndrome is a rare entity in clinical practice and its treatment depends on its suspicion and early diagnosis. Methods We report the clinical case of an adult with electrical burn in the upper limbs, who during the hospital stay presented compartment syndrome, was made the opportune diagnosis and was taken to early fasciotomy with adequate evolution. This manuscript aims to conduct a review of the literature and inform the reader about the fundamental aspects for the suspicion of this pathology. Results Among the characteristics of this syndrome is the decrease in tissue perfusion, with mechanical compression of the vascular flow due to an increase in the content of the compartment and a decrease in the continent. The main symptom is exaggerated pain with respect to the injury, associated with paresthesias, pallor and coldness. Conclusions In addition to the limitation in the mobility of the fingers and the hand, the main symptom of compartment syndrome is pain. Excessive pain should always alert us and make us suspect a compartment syndrome. In addition, the pain caused by passive stretching of the muscles is a more sensitive clinical finding in a developing compartment syndrome.(AU)

Serum Prealbumin Affected More by Serum CRP Than by Residual Burned Surface Area

PURPOSE: Prealbumin is known as a biochemical marker for assessing nutritional status, and it is influenced by a systemic inflammatory condition. This study aims to find any correlation between patients' low serum prealbumin in electrical burn and unhealed burn surface area and insufficient nutritional support. METHODS: Data were collected by a review of the medical charts of patients admitted to Hanil General Hospital for electrical burn. Laboratory results such as prealbumin, albumin, total lymphocyte count (TLC), and C-reactive protein (CRP) were collected and tested every week. Residual burn surface area (residual BSA) during a specific period was calculated from the surgery record. Statistical analysis was conducted using Pearson's correlation and multiple regression analysis. RESULTS: A total of 30 subjects were selected, all male. Average total burn surface area was 20.9±14.9%, and patients were operated on about three times after admission. There was statistical significance among all variables in Pearson's correlation test, but in multiple regression analysis, albumin and CRP were significant compared with prealbumin. CONCLUSION: The results could indicate that burn causes a systemic inflammatory reaction, which could affect the serum prealbumin level. Further study concerning the biological plausibility of each variable is needed.

Fisiopatología, manifestaciones sistémicas y secuelas de la fulguración en seres humanos / Pathophysiology systemic manifestations and sequelae of electrocution in humans

Un rayo es un impulso masivo de corriente unidireccional creado por un gradiente de electrones entre dos nubes o una nube y la tierra. El trauma eléctrico por lo general no es mortal, sin embargo se asocia a una serie de complicaciones médicas de importancia. Las secuelas están determinadas tanto por la intensidad de la corriente como por la duración de la aplicación energética. Las lesiones por electrofulguración ocurren por distintos mecanismos: golpe directo, lesión de contacto, “side splash”, corriente por tierra y trauma contuso. La electricidad atmosférica causa diferentes tipos de lesiones a nivel de la piel, como es el caso de las quemaduras lineales, punteadas, térmicas y en plumaje. Las figuras de Lichtenberg son patognomónicas de la electrofulguración. Además del efecto sobre el sistema tegumentario, se documentan lesiones cardiovasculares, respiratorias, gastrointestinales, oculares, auditivas y neurológicas. Cuando se presenta una muerte por electrofulguración, como pocas veces es presenciada y ocurre en espacios abiertos, se debe realizar un estudio exhaustivo del cadáver y del lugar del suceso para descartar otras causas de muerte natural o violenta. En Costa Rica en el año 2011 se presentaron 7 muertes por electrofulguración, principalmente durante la juventud y adultez temprana y a nivel de la zona rural, siendo el principal mecanismo de lesión el golpe directo.

Lightning is a massive unidirectional current that depends of an electron gradient; this electric flow travels from one cloud to another or to the ground. Electric trauma generally is not lethal, however, it is associated to several complications. Sequelae are determined both by the current strength and by the duration of the exposure. Lightning damage occurs by different mechanisms: direct strike, contact injury, side splash, ground current, and blunt trauma. Atmospheric electricity causes different skin lesions such as linear, punctate, thermal, and plumage burns. Lichtenberg figures are pathognomonic for lightning. Besides the effect on the integumentary system, respiratory, gastrointestinal, ocular, auditory, cardiovascular, and neurological injuries are documented as well. When lightning causes death, it usually happens in open places without witnesses. An exhaustive study of the cadaver and the setting of the event should be accomplished in order to exclude natural or violent causes of death. In Costa Rica in 2011, there were seven deaths related to lightning; young adults predominated and most took place in rural areas, being direct strike the main mechanism of damage.

Descriptive Study of Occupational Accidents and their Causes among Electricity Distribution Company Workers at an Eight-year Period in Iran

BACKGROUND: Occupational accidents are unplanned events that cause damage. The socio-economic impacts and human costs of accidents are tremendous around the world. Many fatalities happen every year in workplaces such as electricity distribution companies. Some electrical injuries are electrocution, electric shock, and burns. This study was conducted in an electricity distribution company (with rotational 12-hour shift work) in Iran during an 8-year period to survey descriptive factors of injuries. METHODS: Variables collected included accident time, age of injured worker, employment type, work experience, injury cause, educational background, and other information about accidents. RESULTS: Results indicated that most of the accidents occurred in summer, and 51.3% were during shift work. Worker negligence (malpractice) was the cause of 75% of deaths. Type of employment had a significant relationship with type of injuries (p < 0.05). Most injuries were electrical burns. CONCLUSION: High rate of accidents in summer may be due to the warm weather or insufficient professional skills in seasonal workers. Shift workers are at risk of sleep complaints leading to a high rate of work injuries. Acquiring knowledge about safety was related to job experiences. Temporary workers have no chance to work all year like permanent workers, therefore impressive experiences may be less in them. Because the lack of protective equipment and negligence are main causes of accidents, periodical inspections in workshops are necessary.

The Role of PCR Waveform by Plethysmography in Electric Burns

PURPOSE: A vast array of injuries result from high voltage electrical damage. The compartment syndrome of forearm prone to have high risk of major amputations, especially in arc burn. Early decompressing fasciotomy has been recommended for the prevention of limb amputations. There are controversies about the effect of fasciotomy. We tried to Pressure Cuff Recording (PCR) wave forms of Plethysmography for the monitoring early signs of vascular compromises in decision of early selective fasciotomy. We investigated the role of PCR wave forms to reduce major amputation rate. METHODS: We reviewed 875 burned limb of 520 electric current damage victims (fasciotomy or amputation were performed, PCR wave forms evaluated) during the last 14 years (from Jan. 1, 1996 to Jun. 30, 2009). We analysed the differences of amputation rates by the currency, input/output, burn types, effects of PGE1 adminstration, fasciotomy time, converting of PCR wave forms. RESULTS: There was no major amputations among low tension victims (minor amputation rate; 0.3%). The minor and major amputation rate were 19.5% and 27.0 in high tension injury. The flash burns rarely made the amputations, but arc burns had 12.1% of minor and 41.2% of major amputations. The direct contact burns had 24.7% of minor and 21.3% of major amputations. Most of the victims had their hand as input and foot as output. The minor and major amputation rate were 26.2% and 10.9% in none-fasciotomy, 8.8% and 48.0% in within 8 hours, 10.0% and 52.9% in 8-24 hours, 9.3% and 63.0% in over 24 hours fasciotomy group. Final normal type (N type) of PCR result had only 3.1% of minor amputations and 3.1% of major amputations. Final obstructive type (O type) had 37.6% of minor amputations, 60.8% of major amputations. Initial stenotic type (S type) of converted to N type had 6.6% amputation, but to O type had 98.7% amputation. CONCLUSION: The early selective fasciotomy are essential to reduce major amputations in high tension injuries, especially in arc burns. The PCR wave form converting to obstructive type could be helpful to predict the possible amputation. The PCR wave form is a good tool to monitor early signs of vascular compromise around fasciotomy. It plays as the index of immediate fasciotomy decision.

Cataratas: una rara complicación de quemaduras eléctricas / Cataracts: a rare complication of electric burns

Introduction: Electric burns are complex lesions with multiple complications. Cataracts are an infrequent complication. There are several case reports, but very few information of its phisiopatology and clinical characteristics in the surgical literature. Objectives: To report the incidence and characteristics of patients admitted to Hospital del Trabajador de Santiago (HTS) with electric burns and secondary cataracts. And review the literature. Patients and Methods: All patients admitted to the HTS with electric burns between 01/01/1999 and 01/01/2009 were included. Their electronic files were reviewed, and their data were tabulated in an Excel sheet. The literature about electric burns and cataracts was reviewed. Results: There were 977 patients admitted with electric burns in the last 10 years, 3 (0.3 percent) of them developed secondary cataracts. All were male, 33, 36 and 64 years old. Two of them had facial burns, only one had the description of the voltage (13.500 v). The time between the burn and the diagnostic of cataract was 6 month, 2 and 4 years. In two cases the cataracts were bilateral and in one case it was unilateral and right sided. All patients received surgical treatment with satisfactory outcomes. Conclusions: Cataracts secondary to electric burns are infrequent. We need more numerous series, with accurate registers to establish some prognostic factors. It is important to have in mind this complication and actively look for it in patients that present with electric burns.

Introducción: Las quemaduras eléctricas producen lesiones complejas con múltiples complicaciones. Las cataratas son una complicación infrecuente. Existen varios reportes de casos, pero escasa difusión en el ámbito quirúrgico de sus características y fisiopatología. Objetivo: Reportar la incidencia y características de la población atendida en el Hospital del Trabajador de Santiago (HTS) con diagnóstico de catarata secundaria a quemadura eléctrica, y presentar una revisión de la literatura sobre el tema. Pacientes y Métodos: Se incluyeron todos los pacientes admitidos al HTS con diagnóstico de quemadura eléctrica, entre el 01/01/1999 y el 01/01/2009. Se revisaron sus archivos electrónicos y se tabularon en una base de datos Excel. Se realizó una revisión sobre el tema. Resultados: En los últimos 10 años ingresaron 977 pacientes con diagnóstico de quemadura eléctrica, de ellos, 3 (0,3 por ciento) tenían cataratas secundarias. Todos de sexo masculino, de 33, 36 y 64 años. En dos de ellos se reportan quemaduras faciales al ingreso y sólo en uno se describe el voltaje de la quemadura (13.500 v). El tiempo transcurrido entre la quemadura eléctrica y el diagnóstico de catarata fue de 6 meses, 2 y 4 años. En dos casos la catarata desarrollada fue bilateral y en un caso fue unilateral derecha. Todos los pacientes recibieron tratamiento quirúrgico con resultados satisfactorios. Conclusiones: Las cataratas secundarias a quemadura eléctrica son poco frecuentes. Hacen falta series más numerosas, con un buen registro, para poder establecer factores pronósticos. Es importante tener presente esta complicación y buscarla dirigidamente en los pacientes con quemadura eléctrica.

Two fusion peptides promote healing of scalded mice / 第二军医大学学报

Objective: To study the therapeutic effect of 2 artificially synthesized fusion peptides on scalded mice. Methods: Two new fusion peptides, M-T508 and M-Tα1, were synthesized based on amino acid sequences selected according to the characteristics of scald (including 3 stages: inflammation, infection and repair by cell proliferation). The 2 peptides were applied for second degree scald burn in mice and the healing of the scald burn was observed. The expression of I collagen, vascular endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and cytokeratin (CK) was detected by immunohistochemical staining. Serum TNF-α concentration was determined by ELISA in the animals and the blood vessel permeability was analyzed by Evans blue staining. Results: The healing periods of scald burns in the 2 peptide groups were 1 week earlier than that in the control group. Immunohistochemical results showed that the expression of collagen I, VEGF, PCNA and CK was all positive in the 2 peptide groups 10 days after scald and negative in the control group. Examination of blood vessel permeability and serum TNF-α concentration in the M-Tα1 and M-T508 groups showed that the 2 fusion peptides had anti-inflammation and anti-infiltration effects in scalded mouse. Conclusion: The synthesized fusion peptide M-Tα1 and M-T508 can promote the healing of scald burns in mice.

Quemaduras en pediatría: [revisión] / Burns in pediatrics patients: [review]

Las quemaduras en la población infantil siempre han sido un problema de salud pública importante el cual no ha sido manejado adecuadamente; cada día consultan más niños con quemaduras de distintos tipos, las más frecuentes son las causadas por líquidos y alimentos calientes, otras menos frecuentes son las eléctricas, por ácidos y dependiendo de la época, la pólvora es otro factor que ha causado aumento de las quemaduras en los niños mayores. En este artículo se describen las quemaduras según su profundidad, severidad y extensión, explicando las diferentes reglas para su medición y localización teniendo en cuenta los sitios especiales así como la implicación de los mismos para el pronóstico del paciente. Además por ser una patología traumática es importante revisar su fisiopatología para así comprender mejor su manejo y entender de esa manera el tratamiento, que varía según el período de tiempo transcurrido desde el evento de la quemadura...

Burns in the infantile population have always been a very important problem of public health that has not been managed appropriately; every day arrive more and more children with burns of different types, the most frequent are those caused by hot liquids, foods, oil, and less frequent ones are the electric and by acids. Depending on the time of the year, the fireworks are other factors that have caused an increase of the cases of burns in the children, especially in the older ones. In this article the burns are shown according to their depth, severity, and extension, it also explains the different rules to measure and locate them, keeping in mind the special places and the implication of the same ones for the patient’s predictions. Besides for be a traumatic pathology, is important to review its physiology, due to understand the special treatment, which is detailed according to the period of time lapsed from the event of the burn...

Electrocution: A six-year study of electrical fatalities.

A six-year study, from January 2001 to December 2006, was undertaken in an attempt to study the pattern of electrical injuries, the cause of death, manner of death and the importance of histopathological examination. The study was comprised of 86 cases brought with history of electrocution, consisting of 69 men and 17 women. Their age ranged from [3] year to [65] year. We had found 97.67% cases of accidental death and 2.32% cases of homicides. Accidental death was more common in age group 21 to 30 years. Of all cases, 45.34% cases were of electric contact, 31.39% cases were of contact and heat and 9.30% cases were of flash burns. In [6] cases no electric mark could be identified. With reference to occupation, 20.93% of deaths occurred in labor class. Considering the histopathological changes, nuclear streaming, dermo-epidermal separation and coagulative necrosis were amongst the commonest lesions.

Trauma abdominal penetrante consecutivo à corrente elétrica industrial / Penetrating abdominal trauma following industrial eletric current

The authors present a case report of a victim of high power electric shock. The main electric lesion was a penetrating abdominal wound with loss of substance of the abdominal wall and an electric lesion of the hepatic segment and of the gallbladder. The surgical treatment included hepatic segmentectomy, cholecystectomy, repair of the abdominal wall with Marlex prosthesis and skin graft, besides the debridment of the lesions of extremities. The postoperative evolution was satisfactory and the follow-up for 6 months didn't show any sequelae.

Two fusion peptides promote healing of scalded mice / 第二军医大学学报

Objective:To study the therapeutic effect of 2 artificially synthesized fusion peptides on scalded mice. Methods: Two new fusion peptides, M-T508 and M-T?1, were synthesized based on amino acid sequences selected according to the characteristics of scald (including 3 stages: inflammation, infection and repair by cell proliferation). The 2 peptides were applied for second degree scald burn in mice and the healing of the scald burn was observed. The expression ofⅠcollagen, vascular endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and cytokeratin (CK) was detected by immunohistochemical staining. Serum TNF-? concentration was determined by ELISA in the animals and the blood vessel permeability was analyzed by Evans blue staining. Results: The healing periods of scald burns in the 2 peptide groups were 1 week earlier than that in the control group. Immunohistochemical results showed that the expression of collagenⅠ, VEGF, PCNA and CK was all positive in the 2 peptide groups 10 days after scald and negative in the control group. Examination of blood vessel permeability and serum TNF-? concentration in the M-T?1 and M-T508 groups showed that the 2 fusion peptides had anti-inflammation and anti-infiltration effects in scalded mouse. Conclusion: The synthesized fusion peptide M-T?1 and M-T508 can promote the healing of scald burns in mice.