Senthil, G (2008) A Study of Management of Acute Electrical Burns of Upper Limbs. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Electrical burn is a unique form of trauma, in which mortality and morbidity are very high when compared to thermal burns. The effects of electrical current depend on the type of current, voltage, tissue resistance, the pathway and the duration.1 Injuries caused by exposure to 1000 volts or greater are considered high tension electrical burns. High tension electrical current may cause 'flash' burns, 'True' electrical burns or secondary thermal burns.2 High-tension electrical burns results in cutaneous injuries, severe damage to underlying muscles, nerves, blood vessels and bones. Every organ system can be injured by the passage of current. Respiratory arrest, cardiac arrest, ventricular fibrillation, renal failure, gangrene of the extremities are some of the early life threatening complications. Upper limb involvement is present in majority of the electrical burn injuries. Upper limbs may have entry point, exit point or both. Injury may range from simple flash burns or low voltage contact burns to devastating gangrene of the limbs. In this study, efficacy of fasciotomy in salvaging upper limbs, adequate debridement with early flap cover using distant flaps in healing of post electric burn wounds and amputation of gangrenous parts of upper limbs were assessed. Electrical burns involving upper limbs are treated by cleaning the wound. Fasciotomy is done in circumferential and deep burns to prevent increase in compartmental pressure. AIMS AND OBJECTIVES: 1. To study the progressive nature of electrical burn injury in upper limbs. 2. To assess the efficacy of fasciotomy as a limb salvage procedure. 3. To analyse the timing of wound debridement and flap cover in the final outcome. 4. To compare our results with studies from other standard institutions. MATERIALS AND METHODS: Study Design and Period: - This prospective study was conducted from September 2005 to March 2008, a period of 2½ years. Study Centre: - This study was conducted in Department of burns ,plastic and reconstructive surgery at kilpauk medical college hospital ,Chennai. Subject Selection:- The inclusion criteria for the study were electrical burns involving upper limb but not exceeding 30% TBSA.Lightning injuries and electrical burns which involved more than 30% TBSA are excluded in this study. A total number of 52 cases were included in this study. All age groups and both sexes were included in this study. Study Methods:- Electrical burn injury is assessed at the time of admission. Extent of injury is marked in the case sheet. Photographs were taken for record purpose. Over the days, progression of the injury is observed and recorded. Fluid requirement is much greater than thermal burns. Ringer lactate is administered 7ml/kg body weight/% of electrical burns initially adjusted to maintain 1 – 1.5 ml/kg/hr urine output. Blood transfusions were given in cases of anemia due to red cell destruction. Intravenous administration of sodabicarbonate and large volumes of intra venous fluids are useful in methemoglobinuria cases. Upper limbs were observed for any signs of increased compartment pressure such as disproportionate pain, more pain on passive stretch, hard shiny skin over a swollen limb and absence of pulse or sensory deficit. RESULTS: Age Distribution: - Involvement of the upperlimb electrical burns were seen more in adult and adolescent age groups (15 – 35 yrs). Prevalence of Electrical burns: - Total number of burns cases admitted in our hospital from September 2005 till March 2008, a period of 2½ years were 3747 cases. • Total number of electrical burns cases admitted in the above period were 69 cases. • Number of electrical burns cases included in this study were 52 cases. • Prevalence of electrical burns in our burns unit was 2% of all burns admissions. Upper Limb Involvement in Electrical Burns: - • Total number of electrical burns admissions during my study period were 69 cases. • Upper limb involvement was seen in 52 cases. • Upper limb involvement in electrical burns injury was 74%. Sex Distribution:- Total number of electrical burns cases included in my study were 52. Males were the victim in majority of cases 51. Etiology:- History of accidental contact of the high tension live wires were seen in 20 cases. There were 17 cases of un-trained causal laborers who sustained electrical burns because of not adhering the safety measures during work. Five adolescent males had accidental electrical wire contact while playing cricket or retrieving kite. Ten cases were electrocuted when they were under the influence of alcohol. Voltage:- 37 cases had high voltage (>1000 V) electrical burns and 15 cases had low voltage (<1000 V) electrical burns. CONCLUSION: A study of management of acute electrical burns of upper limbs was done in 52 cases in our institution in a period of 2½ yrs and the following conclusions were drawn. 1. Early fasciotomy, repeated debridements, non postponement of definitive skin cover (SSG/flap) have helped in reducing the morbidity and improving the quality of life of the patient apart from reducing total hospital stay. 2. The key of success still remains in meticulous debridement of the non-viable tissues, thereby preparing the bed for early skin cover. 3. Pedicled distant flaps are reliable, durable and easy to perform for the post electrical burn defects of the upper limbs, which gives predictable results. 4. Pre-burn conditions such as anemia, greatly influence the final outcome. 5. Early wound debridement and skin cover has helped in reduction in the rate of amputations and faster wound healing. However reconstruction by flap cover has been delayed in some cases because of the poor general condition of the patients and the presence of extensive injuries over various regions of the body.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Acute Electrical Burns ; Upper Limbs ; Management. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:58 |
| Last Modified: | 12 Oct 2017 01:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3576 |
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