Burns related to electrosurgery - Report of two cases / Queimaduras relacionadas à eletrocirurgia - Relato de dois casos

Abstract Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.

Resumo A eletrocirurgia é uma tecnologia que se desenvolveu muitos nos últimos anos e se tornou um instrumento de grande importância na cirurgia moderna. A maioria dos equipamentos é considerada segura, embora existam riscos relacionados ao seu uso. Várias lesões podem ser causadas por eletrocautérios, as queimaduras são as mais frequentes e temidas. Relatamos dois casos de queimaduras relacionadas ao uso do bisturi elétrico e promovemos uma revisão de literatura, pois o conhecimento dos fundamentos da eletrocirurgia, seu uso correto, a escolha de um equipamento seguro, o monitoramento constante e a investigação imediata diante de quaisquer suspeitas com certeza podem melhorar a experiência operacional para ambos, cirurgião e paciente.

[Burns related to electrosurgery - Report of two cases]. / Queimaduras relacionadas à eletrocirurgia ­ Relato de dois casos.

Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.

Destrucción del grupo muscular anterior de la pierna en un paciente con quemadura eléctrica / Destruction of the anterior muscle group of the leg in a patient with electrical burns

Las quemaduras eléctricas son lesiones traumáticas que conducen a necrosis hística de variable extensión y profundidad que se acompañan de gran destrucción muscular y que son capaces de generar grandes secuelas invalidantes o deformantes, e incluso, de ocasionar la muerte. En estas lesiones el daño es mayor en las inserciones tendinosas y en las regiones periósticas, sobre todo en los grupos musculares profundos; los vasos sanguíneos se trombosan progresivamente y son responsables de la necrosis secundaria que dificulta la circulación a la zona afectada. Tanto la amplia afectación muscular como la vascular llevan a la amputación de miembros en el 60 por ciento de las víctimas y a serias limitaciones motoras. Se presenta un paciente de 21 años, del sexo masculino y la raza blanca, con antecedentes de salud anterior y obrero de la Empresa Eléctrica que sufrió una lesión térmica eléctrica que destruyó todo el grupo muscular anterior de su pierna derecha y dejó una estrecha franja posterior de tejido intacto; aunque se discutió la posible amputación, se prefirió la conducta expectante al comprobar que el escaso tejido viable garantizaba la adecuada irrigación sin edema y con recuperación satisfactoria. Al egreso se comprobó una limitación en la flexión del pie que prácticamente no afectaba la marcha del paciente(AU)

Análise de pacientes internados por queimadura elétrica / Analysis of patients admitted for electrical burns

Introdução: Quando se comparam os dados referentes à gravidade, como uso de parâmetros como grau de incapacidade permanente das vítimas sobreviventes, enfatiza-se ainda mais a gravidade dos acidentes por energia elétrica. As vítimas costumam ser adultos jovens, do sexo masculino, em ambiente de trabalho. Do ponto de vista econômico, os acidentes causados por energia elétrica são de alto custo, pois costumam incidir sobre adultos jovens e tecnicamente diferenciados. O objetivo desse estudo é analisar os casos de acidentes ocupacionais decorrentes de queimadura elétrica em nosso serviço, com o intuito de conscientização, e alertar instituições governamentais e não-governamentais quanto à importância de sua prevenção. Método: Estudo retrospectivo transversal das internações dos anos de 2009 e 2010, a partir da coleta de dados em banco de dados do Centro de Tratamento de Queimados do Hospital Municipal Souza Aguiar, sendo analisados os seguintes dados: sexo, idade, local de ocorrência, porcentagem da superfície corporal queimada (SCQ), época do ano e taxa de mortalidade. Resultados: Foram acometidos 26 pacientes por queimadura elétrica, sendo todos do sexo masculino, com idade média de 29,5 anos. O acidente de trabalho foi o mais importante representando 38,46%, seguido de via pública (23,07%) e domiciliar (15,38%). A porcentagem do SCQ média: 0-9% (11,53%), 10-19% (34,61%), 20-29% (30,76%), 30-39% (30,76%) e 40-49% (3,84%). A taxa de óbito foi de 7,69%. Conclusão: Aconselha-se não fazer economia quanto aos gastos com prevenção e investir na pesquisa de novos métodos de tratamento capazes de diminuir o período de inatividade e o grau de incapacidade do trabalhador.

Introduction: When comparing the data on gravity, through parameters such as the degree of permanent disability of the surviving victims, it is emphasized further by the severity of electrical accidents. The victims are usually young adult males in the workplace. From an economic standpoint, accidents caused by electricity are expensive, because young adults tend to focus on differentiated and technically. The purpose of this study is to analyze the cases of occupational accidents due to electrical burn in our service, in order to raise awareness and alert governmental and non-governmental organizations on the importance of prevention. Methods: Cross-sectional retrospective study of admissions for the years 2009 and 2010, from the collection of data in the database of the Burn Treatment Center of the Hospital Municipal Souza Aguiar, and analyzed the following data: sex, age, place of occurrence, percentage of burned surface área (BSA), time of year and the mortality rate. Results: Twenty-six patients were affected by electrical burn, being all male, mean age 29.5 years. The accident was the most important work representing 38.46%, followed by road (23.07%) and home (15.38%). The average percentage of the BSA: 0-9% (11.53%), 10-19% (34.61%), 20-29% (30.76%), 30-39% (30.76%) and 40-49% (3.84%). The death rate was 7.69%. Conclusion: It is advisable not to make the economy and spending on prevention and investing in research of new treatment methods can reduce the period of inactivity and the degree of disability of the worker.

Effects of electrocautery to provoke endovascular thermal injury / Efeitos do eletrocautério para provocar lesão térmica endovascular

PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular.

Effects of electrocautery to provoke endovascular thermal injury.

PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

Electrical burns: a retrospective analysis across a 5-year period.

This study aims to review the experience, at an institution, with patients who suffered electrical burns and study the peculiar characteristics of this type of burn as well as its complications and epidemiological aspects. The study includes medical records of patients with electrical burns who were admitted to the Burn Unit of Hospital das Clínicas in São Paulo, Brazil, from November 2001 to October 2006. They were classified into four categories: high voltage (> or =1000 V), low voltage (<1000 V), 'flash burn' (in which there is no electrical current flow through the body of the patient) and burns caused by lightning. The complications were more severe and common in the high-voltage group, while longer hospital stays and more complex surgical procedures due to the greater depth of burns were also observed in this group. High-voltage burns are mainly labour-/occupation-related. The majority of the patients were young men at the beginning of their professional lives. This factor generates an important socio-economic impact due to the high incidence of sequelae, resulting in amputations, rendering them unable to maintain their occupations.

Utilization of skin flap for reconstruction of the genitalia after an electric burn.

The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.

Utilization of skin flap for reconstruction of the genitalia after an electric burn

The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.

Burns as a complication of the use of diathermy.

Surgical diathermy is an invaluable aid in modern surgery, and most contemporary diathermy machines are considered safe. The literature has proven to be very sparse in terms of reference to complications, although prolonged courses of treatment are required in individual cases. We report a case of burns that occurred during a saphenous vein coronary bypass graft caused by the inadequate use of the electrosurgical materials. Care should be taken in the use of these resources to avoid complications of this kind.

"Train surfers": analysis of 23 cases of electrical burns caused by high tension railway overhead cables.

The term "train surfers" describes a group of adolescents from the outskirts of the city of Rio de Janeiro, who are compelled by the overcrowded railway trains to travel on the roofs of the wagons. Collision with electrical high-tension wires is a relatively frequent occurrence, causing extensive and complex injuries. This study analyzes this clinical and surgical phenomenon which has caused over 100 fatalities in more than 200 registered accidents over the past 10 years.

Lesiones por electricidad en pediatría / Injuries by electricity in pediatrics

Desde el comienzo de los tiempos la gente ha visto la electricidad con miedo, poco se sabía del mecanismo de daño hasta que conenzó su uso controlado hace alrededor de 150 años; desde entonces, se han podido definir sus propiedades físicas y a través de éstas conocer la fisiopatología de sus efectos en el ser humano. Las lesiones por corriente eléctrica son relativamente poco frecuentes, constituyendo entre el 3 y 8,9 por ciento de las admisiones en las unidades de quemados; las tasas de natalidad también son bajas; sin embargo, la incapacidad que generan, tanto a corto como a largo plazo constituye el principal motivo de preocupación, sumado al hecho de que con la creciente disponibilidad de artefactos eléctricos la frecuencia de este tipo de lesiones ha ido en aumento. Según diversos estudios clínicos, el 22 por ciento de los pacientes hospitalizados por quemaduras eléctricas corresponde a niños entre 0 y 18 años, y en el 73,7 por ciento de los casos el accidente se produce mientras juegan, de lo cual se desprende que la prevención es un pilar fundamental en el manejo de este tipo de lesiones en pediatría

[Electrical burns of the upper limbs]. / Queimaduras elétricas dos membros superiores.

During a period of 27 months, between 1991 and 1993, 15 patients with upper limb lesions caused by electrical hazards were admitted in the Burn Emergency Service of the Hospital das Clinicas-FMUSP. This lesion is usually a dramatic condition and requires a sound physiopathologic knowledge by the surgeon. These accidents may have permanent incapacitating sequelae, and due to long periods of treatment (2 months), social-economic costs are very high. Based on our experience, we suggest a less aggressive approach (no amputation at emergency), and a close continuous surveillance.