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.
JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 SOME 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 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 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) 72 JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 RESULTS * Total burn surface area (n = 122): ≤ 5%: 41 patients (33.61%); - 10%: 66 patients (54.09%); 11 - 20%: 11 patients (9.02%); 21 - 30%: patients (2.46%); 31 - 40%: patients; > 40%: patient (0.82%) Total burn surface area ≤ 10% occupied high rate (87.71%) * Deep burn area (n = 118): - 5%: 83 patients (70.34%); - 10%: 21 patients (17.80%); 11 - 20%: 11 patients (9.32%); 21 - 30%: patients (1.69%); > 30%: patient (0.85%) Deep burn area from - 5% of the body area constituted high rate (70.34%) * Depth of burn injuries (n = 122): Pure superficial burns: 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) Deep degrees Number of patients Percentage of patients (%) First, second and third-degree 37 30.33 Fourth-degree 113 92.62 Muscle tendon necrosis 84 68.85 Joint bone necrosis 73 59.83 Nerve blood vessel necrosis 68 55.73 Fifthdegree 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 73 JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 The rate of amputation was very high (22.13%) Picture 2: The second gangrenous injury of right anterior tibial blood vessels and nerves * Position of burn injury (n = 122): Picture 3: Leg amputation by electrical burn 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: 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: patients (1.64%); ophthalmic maxillo-facial injuries: patients (1.64%); arthritis: patients (6.56%) Picture 4: Necrotic debridement of electrical burn injury 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: patients (1.64%) 74 Picture 5: Amputation by electrical burn injuries JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 DISCUSSION Electrical burn usually has no large burn area Skin injuries 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 fourthdegree, fifth-degree burns and underneath deep injuries 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%) REFERENCES Quang Hung Do Study on the clinical characteristics and surgical treatment of burns by electric currents Ph.D Thesis in medicine Military Medical University Hanoi 1998 75 JOURNAL OF MILITARY PHARMACO-MEDICINE N07-2016 The Trung Le Burns, Specialized Knowledge, Medical publishers 2003 always necessary? Journal Trauma - Injury infection and Critical care 1996, 40, pp.584-589 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 Ohashi M, Koizumi J, Hosoda Y et al Correlation between magnetic resonance imaging and histopathology of an amputated forearm after an electrical injury Burns 1998, 24 (4), pp.122-135 Haberal M Electrical burns: a five year experience - 1985 Evans Lecture J Trauma 1986, 26 (2), pp.103-109 Luce A, Gottieb, Steven E High - Voltage electrical injuries Journal Trauma - Injury Infection & Critical Care 1982, 22 (7), p.627 Mann, Roberta MD, Gibran, Nicole MD, David MD Is immediate decompression of high voltage electrical injuries to upper extremily 76 Vedung S, Arturson G, Wadin K, Hedlund A Angiographic findings and need for amputation in high tension electrical injuries Scand J Plast Reconstr Hand Surg, 2006, 24, pp.225-231 Yuan YH, Chung LC, Shin CP Analysis of factors influencing limb amputation in high voltage electrically injuried patients Burn 2011, 37, pp.673-677 ... Necrotic debridement of electrical burn injury The common in-site complications of electrical burns were compartment syndrome and secondary bleeding * Surgical interventions (n = 122): Fasciotomy:... rate of amputation was very high (22.13%) Picture 2: The second gangrenous injury of right anterior tibial blood vessels and nerves * Position of burn injury (n = 122): Picture 3: Leg amputation... Deep burn area from - 5% of the body area constituted high rate (70.34%) * Depth of burn injuries (n = 122): Pure superficial burns: patients (3.28%); combination of superficial and deep burns: