[Mechanism and prevention and treatment strategy of progressive injury in high-voltage electric burns].

High-voltage electric burn is one of burns that can cause severe damages to tissue and organs. Clinically, progressive injury in high-voltage electric burns is a key pathological change that affects the level of amputation and the success rate of treatment. At present, the exact definition and mechanism of progressive injury in high-voltage electric burns have not been elucidated, and the clinical treatment is mainly symptomatic treatment. Relevant research data on the mechanism and treatment of progressive injury in high-voltage electric burns are lacking. This paper analyzes and summarizes the mechanism, diagnosis, treatment, and common outcome of progressive injury in high-voltage electric burns, and provides a reference for the mechanism research, clinical diagnosis and treatment of progressive injury in high-voltage electric burns.

[Serum creatine phosphokinase as a predictor of upper limb amputation in electrical trauma]. / Soderzhanie kreatinfosfokinazy v plazme krovi kak prediktor amputatsii verkhnei konechnosti pri elektrotravme.

OBJECTIVE: To study the relationship between serum creatine phosphokinase and outcomes of injury in victims with electrical burns. MATERIAL AND METHODS: Among 40 patients with electrical injury, 7 (18%) ones underwent upper limb amputation. There were 37 (92.5%) men and 3 (7.5%) women aged 37 (28; 47) years. We analyzed total serum creatine phosphokinase and MB fraction on the first day in patients with and without amputations. RESULTS: Total serum creatine phosphokinase exceeded the upper reference value in 11 out of 33 patients without amputation and in all 7 patients with limb amputation (p=0.001). Patients with limb amputation had significantly higher total serum creatine phosphokinase and MB fraction (p<0.001 and p=0.030, respectively). Logistic regression equation showed that high total serum creatine phosphokinase significantly influenced amputation rate (p<0.001), as evidenced by odds ratio (42.7, 95% CI 3.5-514.8). ROC analysis revealed the cut-off value of total serum creatine phosphokinase (950 IU/L). Sensitivity was 100% (63; 100), specificity - 94% (86; 94), positive predictive value - 78% (49; 78), negative predictive value - 100% (92; 100). CONCLUSION: Total serum creatine phosphokinase depends only on severity of electrical and flame burns. Serum creatine phosphokinase is a predictor of upper limb amputation in patients with electrical injury. Total serum creatine phosphokinase ≥ 950 IU/L is significant for upper limb amputation (in CK-MB fraction within the reference values).

Creatina fosfocinasa MB como marcador diagnóstico de disfunción miocárdica en pacientes pediátricos con quemadura eléctrica / Creatine phosphokinase MB levels as a diagnostic marker of myocardial dysfunction in pediatric patients with electrical burns

Resumen Introducción: La disminución de la fracción de eyección ventricular izquierda (FEVI) como consecuencia de una disfunción ventricular se reporta dentro de las alteraciones cardiacas secundarias a una lesión eléctrica. Como complemento de la exploración física, la ecografía cardiaca enfocada (FoCUS) permite una evaluación rápida, no invasiva, que da información para contribuir a tomar mejores decisiones terapéuticas, sobre todo en pacientes en estado crítico. El objetivo de este estudio fue explorar la utilidad de la creatina fosfocinasa MB (CPK-MB) como marcador diagnóstico de disfunción miocárdica en pacientes de 6 a 18 años con quemadura eléctrica. Métodos: Durante el periodo de noviembre de 2018 a agosto de 2019 se llevó a cabo un estudio transversal analítico de 10 pacientes, de 6 a 18 años de edad, con quemadura eléctrica, en quienes se obtuvo el porcentaje de FEVI a través del protocolo FoCUS. Posteriormente, el porcentaje de FEVI se correlacionó con los valores de CPK-MB y el porcentaje de superficie corporal quemada (SCQ) en las primeras 24 horas después de la lesión. Resultados: Se encontraron 10 casos de quemadura eléctrica, ocho de sexo masculino y dos de sexo femenino, con una media de edad de 13 años. El 80% de estos casos presentó disminución leve de la FEVI (45-59%). Al realizar el protocolo FoCUS se reportó hipocinesia miocárdica en siete pacientes. Se encontró una correlación moderada entre la FEVI y los valores de CPK-MB (r = −0.671), aunque no se observó correlación entre la FEVI y la SCQ. Conclusiones: La ecografía cardiaca influye en la toma de decisiones y mejora el pronóstico de estos pacientes.

Abstract Background: The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods: From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results: We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = −0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions: The cardiac ultrasound influences decision making to improve the prognosis of these patients.

Creatine phosphokinase MB levels as a diagnostic marker of myocardial dysfunction in pediatric patients with electrical burns.

Background: The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods: From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results: We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = -0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions: The cardiac ultrasound influences decision making to improve the prognosis of these patients.

Background: Introducción">La disminución de la fracción de eyección ventricular izquierda (FEVI) como consecuencia de una disfunción ventricular se reporta dentro de las alteraciones cardiacas secundarias a una lesión eléctrica. Como complemento de la exploración física, la ecografía cardiaca enfocada (FoCUS) permite una evaluación rápida, no invasiva, que da información para contribuir a tomar mejores decisiones terapéuticas, sobre todo en pacientes en estado crítico. El objetivo de este estudio fue explorar la utilidad de la creatina fosfocinasa MB (CPK-MB) como marcador diagnóstico de disfunción miocárdica en pacientes de 6 a 18 años con quemadura eléctrica. Métodos: Durante el periodo de noviembre de 2018 a agosto de 2019 se llevó a cabo un estudio transversal analítico de 10 pacientes, de 6 a 18 años de edad, con quemadura eléctrica, en quienes se obtuvo el porcentaje de FEVI a través del protocolo FoCUS. Posteriormente, el porcentaje de FEVI se correlacionó con los valores de CPK-MB y el porcentaje de superficie corporal quemada (SCQ) en las primeras 24 horas después de la lesión. Resultados: Se encontraron 10 casos de quemadura eléctrica, ocho de sexo masculino y dos de sexo femenino, con una media de edad de 13 años. El 80% de estos casos presentó disminución leve de la FEVI (45-59%). Al realizar el protocolo FoCUS se reportó hipocinesia miocárdica en siete pacientes. Se encontró una correlación moderada entre la FEVI y los valores de CPK-MB (r = −0.671), aunque no se observó correlación entre la FEVI y la SCQ. Conclusiones: La ecografía cardiaca influye en la toma de decisiones y mejora el pronóstico de estos pacientes.

Termografía portátil en Cirugía Plástica: el nuevo estetoscopio del cirujano reconstructivo / Portable thermography in Plastic Surgery: the new reconstructive surgeon's stetho-scope

INTRODUCCIÓN Y OBJETIVO: La termografía puede medir la longitud de onda de la radiación infrarroja emitida desde el cuerpo y calcular su temperatura. Es un método pasivo, no invasivo y no emite radiación ionizante. La mayoría de los estudios en Cirugía Plástica han investigado su utilidad en la localización de perforantes y en la evaluación de la profundidad de las quemaduras. La termografía portátil tiene la ventaja de su bajo costo y de poder ser utilizada junto a la cama del paciente. El objetivo de este estudio es presentar nuestra experiencia en el uso de la termografía portátil y realizar una revisión respecto a las aplicaciones de esta tecnología en Cirugía Plástica Reconstructiva. MATERIAL Y MÉTODO: Estudio descriptivo basado en la experiencia acumulada sobre el uso de termografía portátil para teléfonos inteligentes en Cirugía Plástica Reconstructiva desde enero de 2017 a diciembre de 2019. RESULTADOS: Describimos la utilidad de la termografía portátil en la planificación de colgajos basados en perforantes, monitorización de colgajos, definición del momento óptimo para realizar el segundo tiempo en colgajos retardados, así como la evaluación de la vitalidad de tejidos en lesiones por desforramiento y quemaduras eléctricas. CONCLUSIONES: La termografía portátil es rápida y fiable en la detección de perforantes y en la diferenciación entre tejidos vitales y necróticos o isquémicos. Es complementaria a otras técnicas imagenológicas, ahorra tiempo en el mapeo o rastreo de perforantes y proporciona además información útil en la estimación de la perfusión de tejidos

BACKGROUND AND OBJECTIVE: Thermography can measure the wave length of infrared radiation emitted from the body and calculate its temperature. It is a passive method, noninvasive, that does not emit ionizing radiation. Most studies in Plastic Surgery have researched its utility in localization of perforators and evaluation of burn depth. Portable thermography has the advantage of having a lower cost, and being able to be performed bedside. The aim of this study is to present our experience with portable thermography and review the uses of this technology in Reconstructive Plastic Surgery. METHODS: Descriptive study based on the accumulated experience on the use of portable thermography for smartphones in Reconstructive Plastic Surgery, from January 2017 to December 2019. RESULTS: We describe the utility of portable thermography in planning flaps based on perforators, flap monitoring, definition of the optimal timing for secondstage operations in vascular delay procedures, as well as assessment of the vitality of tissues in degloving injuries and electrical burns. CONCLUSIONS: Portable thermography is reliable and fast in detecting perforators and defining viable and ischemic/necrotic tissue. It is complementary to other imaging techniques, saving time in mapping or tracing perforators and provides useful information in estimating well-perfused tissue

Electrical burns and complications: Data of a tertiary burn center intensive care unit.

BACKGROUND: To review the records of electrical burn patients hospitalized in our burn intensive care unit (ICU) and to report the complications together with our treatment results. METHODS: Demographic data, burn mechanism, presentation, percentage of burn total body surface area (TBSA), abbreviated burn severity index (ABSI) scores, complications and treatment approaches of electrical burn patients admitted to our burn ICU between September 2017 and August 2018 were evaluated retrospectively in this study. RESULTS: Electrical burn injury patients consisted of 17.9% of the patients who were hospitalized in burn ICU (n=139). All patients were male, and the median age was 27.0 years. Twenty-three patients (92%) were burned with high voltage electricity. The median percentage of burn TBSA score was 20.0. Eight patients had an accompanying head, a vertebra or extremity injuries. Sixteen patients (64%) were injured at work. Sixteen patients (64%) recovered with complications. ICU stay and total hospital stay were significantly higher in the group that healed with complications (p=0.005 and p=0.001, respectively). However, no significant differences were detected in burn TBSA and ABSI scores. TBSA and ABSI scores were correlated with ICU and total hospital stay. CONCLUSION: The proportion of our electrical burn patients is higher than reported in the literature. Burn TBSA and ABSI scores seem unrelated to prognosis. As the majority of patients are burned with high-voltage electricity at work, these injuries can be reduced by following occupational safety principles. Because of the high rate of complications in electrical burns, an experienced health team in well-equipped centers should treat patients in accordance with updated guidelines.

Just another railway fatality.

We report on a 56-year-old male who was found dead on railroad tracks, equipped with overhead high-voltage power lines (15,000 V AC). Apparently, the body had been hit by a passing train and completely severed at the mid-abdominal level. Based on this apparently unequivocal finding, the police initially assumed a fatal railway accident or suicide. However, close examination of the deceased's clothes revealed heat damage to at least four overlying layers of clothing in different locations. The rubber soles of his heavy leather shoes showed small holes in blackened areas underneath the toes. Furthermore, both socks revealed tears and fabric defects with burnt rims, again most prominent in the area of the toes. Skin burns, consistent with electric burns, and blistering were detected on the deceased's hands and feet. A broken fishing rod was found in the proximity. On autopsy, multiple injuries caused by severe blunt force with subsequent skull fracture and brain laceration as well as multiple injuries to the spinal column and rib fractures were found and visceral organs displayed multiple lacerations. However, the lack of relevant hematomas argues that these injuries were inflicted postmortem. Histological examination confirmed the presence of electric burns from electrocution. Based on the results of the forensic-pathological examination and additional investigations carried out at the scene of death, we could demonstrate that this highly unusual death was caused by an electrocution after contact of the fishing rod with the high-voltage power line and not by overrunning by the train.

Sociodemographic and culture results of paediatric burns.

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C-reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third-degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase-negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.

[Strengthen standardized diagnosis and treatment to improve the prognosis of electric burn].

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.

Ilioinguinal Flap Combined With Tensor Fascia Lata Muscle Flap to Repair Deep Electrical Burns in the Lower Abdomen: A Report of Two Cases.

INTRODUCTION: Electrical burns are caused by the conversion of electrical energy flowing through the body into heat energy, which can cause coagulative necrosis of the skin and deep tissues. Deep tissue damage is often more serious than skin damage. Electrical burns have the characteristics of destructive and progressive damage and present the common symptoms of severe local tissue damage accompanied by a wide range of deep tissue necrosis, resulting in injury of nerves, blood vessels, bones, and internal organs. Autologous skin grafting alone cannot effectively cover deep tissues or repair electrical burn wounds. CASE REPORT: This article describes 2 patients with deep electrical burns in the lower abdomen that showed extensive skin and soft tissue damage, partial necrosis of abdominal muscle tissue, and weak abdominal wall. As a single tissue flap was too small to effectively cover the defect wound, ilioinguinal flap and tensor fascia lata muscle flap were utilized in both cases with good outcomes. These flaps survived completely, and the wounds were effectively repaired. After repair, the shape was satisfactory, and the function of the lower abdomen was normal. CONCLUSIONS: Transfer of flaps from a site near the wound for repairing electrical burns is convenient for transfer with minimal surgical trauma and a simpler operating procedure than the free flap.

High Voltage Electric Burn Repair of the Forehead by Reverse Flow Temporalis Muscle Flap.

Repairing soft tissue defects of the forehead which exposes the bare bone is a dilemma with few reconstructive techniques for plastic surgeons. Forehead is an important aesthetic unit of the face which is covered with the glabrous skin. Due to the relative lack of similar mobile tissue locally, reconstruction of large soft tissue defects of the forehead region by local flaps is demanding. Temporalis muscle flap does not reach to the midline of the forehead region because of the insufficient length of the deep temporal vascular system. During the transfer of the muscle, only a small volume and size of the muscle can reach to the defect, remaining most of the muscle bulk in the pedicle and a relatively limited arc of rotation, thus a small volume of usable tissue at the distal portion of the flap. We successfully used reverse flow temporalis muscle flap for the purpose of eliminating the above-mentioned disadvantage of temporalis muscle flap in a 23-year-old male patient who sustained a high-voltage electrical burn resulting 12 × 8 cm left forehead defect exposing the bare bone.

[HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]

INTRODUCTION: Electrical injury is an infrequent but potentially devastating form of multisystem injury associated with high morbidity and mortality. Despite significant improvement in injury prevention and implementation of safety protocols at work places, electrical injury accounts for more than 500 deaths per year in the United States with a mortality rate of 10-30%. Electrical injuries are traditionally divided into low-voltage electric power injuries (less than 1,000V) and high-voltage )more than 1,000V). In contrast with other types of trauma, high voltage injuries present some rather unique problems that require a high index of suspicion and awareness of all possible manifestations. Electrical injury should be viewed and managed as a multisystem injury, since there is virtually no organ that is protected against it. The most essential concept of successful management of patients who sustain high voltage injury is that there is no relationship between skin burn, vital organs involvement and severity of injuries. This review aims to provide a comprehensive overview of reported high voltage electrical injury manifestations in an attempt to gain a better understanding of the distribution of morbidity and clinical features of the injury. We tried to encompass most of the reported cases of high voltage electrical injuries in order to give the readers a general view of the spectrum of injuries that can be encountered in victims suffering high voltage current, aiming to increase the awareness of emergency care and trauma teams to this rare but dangerous and potentially fatal type of injury.

Luminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review.

Over the past decade, catheter ablation for atrial fibrillation has emerged as an important rhythm control strategy. One of the most dreaded complications of this procedure is atrio-esophageal (AE) fistula formation, which is relatively rare but usually fatal. Esophageal tissue injury during ablation appears to be a precursor to the formation of AE fistulae. Luminal esophageal temperature (LET) monitoring is one of the most commonly utilized strategies to mitigate this risk, despite little evidence that it reduces esophageal injury. The incidence of AE fistulae appears to be on the rise, despite the widespread use of LET monitoring. This may be due to the advent of improved large lesion technology including force-sensing catheters and the use of high power, although AE fistulae have also been observed with the use of low power along the left atrial posterior wall. Currently available discrete sensors probes, whether single or multiple, do not appear to significantly reduce injury rates. The purpose of this manuscript is to systematically review the incidence of esophageal thermal injury with and without LET monitoring and review the factors that may be associated with increased risk of injury.

Quemadura por rayo globular. A propósito de un caso / Burn by ball lightning. Case report

Se presenta un caso de quemadura por rayo globular en un paciente pediátrico. El objetivo de este reporte es dar a conocer los aspectos generales de las quemaduras por rayo e informar sobre un fenómeno natural rara vez visto: el rayo globular. Paciente varón de tres años que, en junio de 2017 sufrió una quemadura en el abdomen causada por un rayo globular que se introdujo en el hogar a través de la chimenea. El paciente ingresó en una unidad de quemados un día después. Durante la estancia hospitalaria no se encontraron alteraciones significativas, aparte de la llamativa lesión dérmica en el abdomen conocida como líneas o figuras de Lichtenberg. El paciente fue dado de alta en pocos días sin ninguna complicación y con la lesión dérmica resuelta. El rayo globular sigue siendo desconocido para la mayoría de la población general, sin embargo, es un fenómeno documentado, pero poco estudiado comparado con otros fenómenos naturales. Consideramos que la prevención sigue siendo una piedra angular en la génesis de las quemaduras, incluso las generadas por la electricidad

We present below a case of globular ray burn in a pediatric patient. The objective of this case report is to make known general aspects of lightning burns and report on a natural phenomenon rarely seen: ball lightning. A 3-year-old male patient who on June 2017 suffered a burn in the abdomen caused by a ball of lightning that was introduced into the home through the fireplace. The patient entered the burn unit. During the hospital stay, no significant alterations were found, other than the striking dermal lesion in the abdomen known as Lichtenberg lines or figures. The patient was discharged within a few days without any complication and with the dermal lesion resolved. Ball lightning remains unknown to most of the general population, however, it is a documented phenomenon, but little studied compared to other natural phenomena. We consider that prevention remains a cornerstone in the genesis of burns, even those generated by electricity

High-voltage electrical injury: Modified surgical technique for optimal defect closuring of extra-large cranial defect.

Electrical burns are group of traumatic injuries with a mortality rate of 3-15%. High-voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high-voltage induced extra-large cranial injury in a 38-year-old man, treated with modified single large rotation flap and a split skin-thickness graft technique, for optimal defect closuring with satisfied aesthetic result.

Wound management and outcome of 595 electrical burns in a major burn center.

BACKGROUND: Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. METHODS: This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. RESULTS: A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. CONCLUSIONS: Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates.

Chemical, Electrical, and Radiation Injuries.

This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management.