Objectives: To research characteristics of electrical burn injury and surgical intervention. Subjects and methods: A prospective, cross-sectional and descriptive study was conducted on 122 electrical burn cases, who were examined and treated at Adult Burn Department at National Institute of Burns.
Trang 1SOME REMARKS ON CHARACTERISTICS OF
ELECTRICAL BURN INJURY AND SURGICAL INTERVENTION
Ho Huu Phuoc*
SUMMARY
Objectives: To research characteristics of electrical burn injury and surgical intervention Subjects and methods: A prospective, cross-sectional and descriptive study was conducted on
122 electrical burn cases, who were examined and treated at Adult Burn Department at National Institute of Burns Results: Total burn surface area ≤ 10%, deep burn and fifth-degree burn occurred in 107 cases (87.71%), 118 cases (96.72%) and 73 cases (59.83%), respectively Upper limb and lower limb burn was found in 91 cases (74.6%) and 93 cases (76.23%), respectively Compartment syndrome was observed in 47 cases (38.52%) 27 cases (22.13%) had to be made amputation Conclusion: Electrical burn injury usually has no large area but causes deep burn and fifth-degree burn to bone The electrical burn injuries are frequently encountered on the limbs relating to a point of input and output of electrical current Compartment syndrome is very common complication of electrical deep burn injury There is high rate of amputation in electrical burn cases resulting in lifelong disability
* Key words: Electrical burn; Amputation
INTRODUCTION
Electrical burns, especially high-voltage
burn can cause very severe injury and
explain the high rate of amputations
Amputations have been indicated when
there is no longer limb preservation treatment
[8] Electrical burn injuries are often deep
and in limbs relating to input and output of
the electric current Amputation aims to
save patient’s life and reduce the mortality
rate When there is completely gangrenous
limb (e.g fifth-degree burn, injuries cause
vascular occlusion, completely necrotic soft
tissue), amputation should be early indicated
to reduce the risk of poisoning and infection
Late amputation is also proposed in
monitoring the progression of secondary
necrosis during the treatment, great vascular
destruction causing limbs necrosis
Our objective was: To make some
remarks on characteristics of electrical burn injury and surgical intervention
SUBJECTS AND METHODS
1 Subjects
A study was carried out on 122 electrical burn cases who were examined and treated
at Adult Burn Department in National Institute of Burns
2 Research methods
Prospective, cross-sectional and descriptive method with the specified criteria
Research parameters included total burn surface area, deep burn area, distribution, position of burn injury, complications, surgery and amputation rate
* 103 Hospital
Corresponding author: Ho Huu Phuoc (huuphuoc103@gmail.com)
Trang 2RESULTS
* Total burn surface area (n = 122):
≤ 5%: 41 patients (33.61%); 6 - 10%: 66 patients (54.09%); 11 - 20%: 11 patients (9.02%); 21 - 30%: 3 patients (2.46%); 31 - 40%: 0 patients; > 40%: 1 patient (0.82%) Total burn surface area ≤ 10% occupied high rate (87.71%)
* Deep burn area (n = 118):
1 - 5%: 83 patients (70.34%); 6 - 10%: 21 patients (17.80%); 11 - 20%: 11 patients (9.32%); 21 - 30%: 2 patients (1.69%); > 30%: 1 patient (0.85%)
Deep burn area from 1 - 5% of the body area constituted high rate (70.34%)
* Depth of burn injuries (n = 122):
Pure superficial burns: 4 patients (3.28%); combination of superficial and deep burns: 33 patients (27.05%); pure deep burns: 85 patients (69.67%) Electrical burn injuries were mainly deep burn (96.72%)
Table 1: Deep degree of the electrical burn injury (n = 122)
First, second and third-degree 37 30.33
Muscle tendon necrosis 84 68.85
Fifth-degree
Nerve blood vessel necrosis 68 55.73
Fifth-degree burn explained high rate Among them, necrosis of muscle tendon, joint bone and nerve blood vessels was equivalent to 68.85%, 59.83% and 54.91%, respectively
Picture 1: Calf muscular gangrenous burn
Trang 3Picture 2: The second gangrenous injury
of right anterior tibial blood vessels and
nerves
* Position of burn injury (n = 122):
Head, face, neck: 14 patients (11.48%);
forequarters and hindquarters: 17 patients
(13.93%); upper limb: 91 patients (74.60%);
lower limb: 93 patients (76.23%); genital
organ and perineum: 3 patients (2.46%)
Injuries in limbs are often attributable
to electrical burns The rates of injuries in
upper limb and lower limb were 74.60%
and 76.23%, respectively
* Local complications of electrical burn
(n = 122):
Compartment syndrome: 47 patients
(38.52%); secondary bleeding: 16 patients
(13.11%); tetanus: 2 patients (1.64%);
ophthalmic maxillo-facial injuries: 2 patients
(1.64%); arthritis: 8 patients (6.56%).
The common in-site complications of
electrical burns were compartment syndrome
and secondary bleeding
* Surgical interventions (n = 122):
Fasciotomy: 47 patients (38.52%); necrotic
debridement: 118 patients (96.72%); limb
amputation: 27 patients (22.13%); split -
thickness skin graft: 102 patients (83.61%);
adipofascial flap: 2 patients (1.64%).
The rate of amputation was very high (22.13%)
Picture 3: Leg amputation by electrical
burn
Picture 4: Necrotic debridement of
electrical burn injury
Picture 5: Amputation by electrical burn
injuries.
Trang 4DISCUSSION
Electrical burn usually has no large
burn area Skin injuries do not correlate
with deep injuries along the path of the
electrical current In our study, total burn
surface area ≤ 10% of the body area was
87.7% and deep burns occupied 96.72%
(118 cases)
Electrical burn is caused by two
mechanisms including heat generated by
electric current in accordance with the law
of Joule - Lentz (Q = k.I2.Rt) and perforated
effect Deep injury to the tissues such as
blood vessels, nerves, muscles, bones
is parallel with the power lines running
through [5] Therefore, injuries of
fourth-degree, fifth-degree burns and underneath
deep injuries do not correlate to the position
of the skin lesions In our study, deep
burns occurred in 118 cases (96.72%)
Fifth-degree burn constituted the high rate
and muscle tendon, joint bone, nerve blood
vessel necrosis accounted for 68.85%,
59.83% and 55.73%, respectively These
injuries can’t be conservative and amputation
is an absolute indication without delay [1]
Deep burn injuries need surgical
intervention, a patient might have to suffer
from several times of surgeries and many
different surgical methods must be
performed from the first stage of burn
injuries until the late stages of covering
injuries to heal wounds Furthermore, in
this research, many surgical methods were
applied such as fasciotomy, necrotic
debridement, skin graft, covering flaps
and amputation when there was no longer
conservative treatment indication
Mann studied on 51 electrical burn cases
with compartment syndrome complication
11 cases (21.6%) in fasciotomy and early necrosis excision cases were amputated with 18 times of surgeries [6] Yuan (2011) studied 22 electrical burn cases with the rate of 40% for amputations [9] Luce studied 31 electrical burn cases, the rate
of amputations was 35.5% [5] Di Vincenti studied 65 electrical burn patients, the rate of amputations was 32.5% Quang Hung Do (1998) reported amputation rate was 40% in electrical burns [5] Xuan Thao Mai (2009) found that amputation rate in electrical burns was 35.72% [3] In our study, 47 electrical burn cases with compartment syndrome complication were made fasciotomy to decompress limbs, among which 27 cases (22.13%) had to be made amputation Amputation is not only treatment method
of saving patient’s life by removal of necrosis tissue, infection source and causes of burn, but also helps to recover more quickly, reduce complications and the mortality rate [2, 7]
CONCLUSION
Through studying on 122 electrical burn cases, we reached conclusion as follows:
- The deep burn injuries were seen in very high rate (96.72%)
- The electrical burn injuries occurred usually on the limbs with upper limb 74.6% and lower limb 76.23%
- The amputation rate was very high (22.13%)
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by electric currents Ph.D Thesis in medicine Military Medical University Hanoi 1998
Trang 52 The Trung Le Burns, Specialized Knowledge,
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3 Xuan Thao Mai Study on the clinical
characteristics and local treatment of high-voltage
burns Ph.D Thesis in medicine Military Medical
University Hanoi 2009
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experience - 1985 Evans Lecture J Trauma
1986, 26 (2), pp.103-109
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