[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).

Injuries Associated With Electrical Flash Burns in Children Caused by E-bike Batteries.

The use of electric bicycles (e-bikes) has increased in China. Alongside this increased use of e-bikes, reports of injuries related to e-bikes have also increased. However, few studies have explored electrical burns from short circuits in e-bike batteries, especially among children. Our study aimed to describe the epidemiology and prognosis of e-bike-related electrical flash burns in children. This retrospective analysis examined the injury patterns and prognosis of flash burn injuries from e-bike batteries among children presenting to the emergency department of a hospital in northern China from 2009 to 2020. Data collected included demographics, mechanism of injury, time of injury, injury site, burn depth, healing time, and patient prognosis. During the study period, 82 children presented to our emergency department with these injuries (boys: n = 64, 78%; girls: n = 18, 22%). The children's mean age was 3.5 (2.5) years. Burns occurred in all months of the year but peaked from May to August (spring and summer). Most burns were to the fingers. All burns were minor injuries that healed within 2 weeks with wound care. With the growing popularity of e-bikes, electric flash burns among children caused by e-bike batteries are increasingly common. Doctors should be aware of this special injury type to offer the correct diagnosis and treatment and provide parents with appropriate information.

Electrocution Due to Fractal Wood Burning: Two Case Reports and a Review of the Medical Literature.

ABSTRACT: Fractal wood burning is a new technique of pyrography that passes an electrical current through a piece of wood resulting in decorative electrical burns. This practice has become increasingly popular with many walk-through tutorials of the process found online. This includes videos of how to build homemade devices fashioned from disassembled microwave oven transformers. There have been 31 reported deaths and many serious injuries due to fractal wood burning resulting in news headlines, warning statements, and an outright ban of the practice at certain woodworking events. The medical community has begun to recognize the danger of fractal wood burning with a few cases of severe burn injuries reported. We report 2 cases of electrocution from fractal wood burning accidents. The scene investigations were examined, including the similarities in the homemade microwave oven transformers that were used, as well as the autopsy findings. The pathophysiology of fractal wood burning and the creation of Lichtenberg figures is discussed as well as the high-voltage injury patterns seen in cases of fractal wood burning accidents. Other cases of electrical injury from fractal wood burning accidents reported in the news and medical literature were then examined in terms of demographics, burn pattern, cardiac findings, and whether a homemade wood burning device was involved.

Reconstruction of Giant Defects Due to Electrical and Radiation Burns in the Lower Leg with Free Anterolateral Thigh Flaps.

The purpose of this study was to introduce reconstruction of giant soft tissue defects of the lower leg caused by high-voltage electrical burns and radiation burns using the free anterolateral thigh (ALT) flap. From March 2017 to January 2018, 6 patients who sustained high-voltage electrical burns and 2 patients who sustained ulcerated radiation burns were reconstructed using the free ALT flap. The mean size of the defects was 19 cm × 32 cm (range, 18 cm × 22 cm to 30 cm × 36 cm). The mean size of the flaps was 22 cm × 34 cm (range, 20 cm × 24 cm to 32 cm × 38 cm). All flaps survived completely. The mean preoperative Functional Analysis Technique Evaluation score was 62 (range, 43 to 74). The mean follow-up period was 16 months (range, 12 to 18 months). At the final follow-up, the mean postoperative score was 90 (range, 86 to 94). The mean improvement was 33% (range, 17% to 54%) with 4 excellent and 4 good results. For extensive, high-voltage electrical, and radiation burns encompassing the lower leg, early treating the giant soft tissue defects with a free ALT flap produces good functional outcomes without significant complications.

Water heating immersion rod fatalities and their injury pattern characteristics.

Immersion rod is a very low-cost electrical device. It is based on simple working principle and widely used in developing nations to heat water for various domestic needs. However, the literature about electrocution caused by it is nearly absent. This is despite its usage being potentially hazardous, with almost sure fatal outcome in cases of mishandling. Data was gathered from 2011 to 2020, via inquest and autopsy reports, regarding electrocution deaths related to it. 6 cases were identified. All consisted of females in domestic settings, as the unique epidemiology in stark contrast to the existing literature on electrocution fatalities worldwide. Injury patterns in a few cases resembled those typical of high voltage electrocution, in these low voltage fatalities. Characteristics of joule burns showed sub-patterns, deviant from electrocution related to other appliances and was again unreported previously. Spark burns and scalds were patterns, quite diagnostic of immersion rod fatalities. A typical pattern for a multitude of injuries in each case is brevity of this study. Injury patterns are presented as a classical guide for further growth of the literature on these types of fatalities.

Power, Lesion Size Index and Oesophageal Temperature Alerts During Atrial Fibrillation Ablation: A Randomized Study.

BACKGROUND: Low radiofrequency powers are commonly used on the posterior wall of the left atrium for atrial fibrillation ablation to prevent esophageal damage. Compared with higher powers, they require longer ablation durations to achieve a target lesion size index (LSI). Esophageal heating during ablation is the result of a time-dependent process of conductive heating produced by nearby radiofrequency delivery. This randomized study was conducted to compare risk of esophageal heating and acute procedure success of different LSI-guided ablation protocols combining higher or lower radiofrequency power and different target LSI values. METHODS: Eighty consecutive patients were prospectively enrolled and randomized to one of 4 combinations of radiofrequency power and target LSI for ablation on the left atrium posterior wall (20 W/LSI 4, 20 W/LSI 5, 40 W/LSI 4, and 40 W/LSI 5). The primary end point of the study was the occurrence and number of esophageal temperature alerts per patient during ablation. Acute indicators of procedure success were considered as secondary end points. Long-term follow-up data were also collected for all patients. RESULTS: Esophageal temperature alerts occurred in a similar proportion of patients in all groups. Significantly, shorter radiofrequency durations were required to achieve the target LSI in the 40 W groups. Less than 50% of the radiofrequency lesions reached the target LSI of 5 when using 20 W despite a longer radiofrequency duration. A lower rate of first-pass pulmonary vein isolation and a higher rate of acute pulmonary vein reconnection were recorded in the group 20 W/LSI 5. A lower atrial fibrillation recurrence rate was observed in the 40 W groups compared with the 20 W groups at 29 months follow-up. CONCLUSIONS: When guided by LSI, posterior wall ablation with 40 W is associated with a similar rate of esophageal temperature alerts and a lower atrial fibrillation recurrence rate at follow-up if compared with 20 W. These data will provide a basis to plan future randomized trials. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02619396.

The Dangerous Life of a Storm Chaser: A Lightning Strike Injury Causing Serious Injury.

Lightning strikes to people are rare events that cause significant injuries and mortality when they do occur. We describe an uncommon case of a storm chaser in Oklahoma who was struck by lightning who suffered cutaneous burns, bilateral tympanic membrane ruptures, as well as pulmonary edema, which is an atypical finding in survivors. This case report highlights several injury patterns seen in lightning strike cases and provides evidence that these patients should be managed at a center with multidisciplinary services available.

Death Due to Fractal Wood Burning: An Emerging Public Health Problem.

The art of pyrography, burning designs in wood, dates back to prehistory. Risks of traditional techniques included cutaneous burns and airway injury. Fractal wood burning is a niche technique using a high-voltage electrical source to burn branched designs into wood. While this technique has grown in popularity, the associated risks are not well understood. We describe a patient who presented to our burn center after sustaining high-voltage electrical injuries while making fractal wood art using an improvised a high-voltage transformer. During the wood-burning process, he contacted the electrodes and suffered full-thickness electrical burns to the neck, chest, and bilateral upper extremities. Bilateral upper extremity fasciotomies were performed on admission. Multiple subsequent operations culminated with autografting to most of the wounds and complex reconstruction of the left thumb. In evaluating online news reports, we found 25 unique individuals with death or injury attributed to fractal wood burning from July 2016 to January 2020. Five sustained substantial injuries, while 20 reportedly died. Ages ranged from 17 years old to the 60s. One death and one injury occurred in females, with the remainder of reports involving males. Of the survivors, four sustained significant upper extremity electrical injuries and three suffered cardiac arrest at the time of injury. Fractal wood burning is associated with devastating high-voltage electrical injuries and death. Prevention efforts should be focused on education about the potential for death and permanently disabling injuries from this art form.

Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies.

Catheter ablation has become an important element in the management of atrial fibrillation. Several technical advances allowed for better safety profiles and lower recurrence rates, leading to an increasing number of ablations worldwide. Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton-pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted. Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes.

Aplicación de la Microcirugía en el tratamiento del paciente quemado eléctrico / Application of Microsurgery in the treatment of the electric burned patient

INTRODUCCIÓN Y OBJETIVO: La Microcirugía como técnica dentro de la Cirugía Plástica no puede faltar en cualquier unidad de quemados para garantizar el tratamiento completo de sus pacientes. Sobre todo en los quemados eléctricos que presentan lesiones muy graves con exposición de tejidos nobles en los que es la primera opción reconstructiva. El objetivo de este artículo es mostrar la experiencia de la Unidad de Quemados del Hospital Universitario Vall d'Hebron de Barcelona, España, en los últimos 10 años en el uso de la Microcirugía en el paciente quemado agudo de etiología eléctrica. MATERIAL Y MÉTODO: Revisión retrospectiva de 19 colgajos realizados entre enero de 2010 y agosto de 2019 en 15 pacientes con quemaduras eléctricas, recogiendo datos de sexo, edad, localización del defecto, superficie corporal quemada (SCQ), colgajo empleado, días hasta la cobertura, tipo de anastomosis arterial, número de venas usadas, supervivencia de los colgajos y complicaciones. RESULTADOS: Destaca que los 15 pacientes fueron varones, con edad media de 36.5 años; SCQ media del 19.5%; el colgajo más usado fue el ántero-lateral de muslo con 9 casos (47.37%), seguido por el de dorsal ancho con 4 casos (21.05%), el colgajo inguinal y el de músculo recto femoral con 2 casos cada uno (10.53% en cada caso) y el de perforante tóraco-dorsal y de fascia temporal superficial con 1 caso cada uno (5.26% en cada caso). La localización más frecuente fue en extremidades inferiores con 12 casos (63.16%), seguida por las extremidades superiores con 5 casos (26.31%) y la cabeza con 2 casos (10.53%). La cirugía de cobertura con el colgajo libre se realizó de media a los 24 días. La anastomosis arterial fue término-terminal en 15 casos (79%). La anastomosis venosa fue término-terminal siempre, anastomosando 2 venas en 5 casos (26.31%) y solo 1 en el resto (73.69%). Dos colgajos fracasaron por congestión venosa (10.53%) y 2 colgajos se complicaron por infección (10.53%). CONCLUSIONES: La reconstrucción de defectos complejos tras quemadura eléctrica es un reto por el escaso número de casos que se presentan y por la propia idiosincrasia de la injuria eléctrica y del paciente quemado. El desbridamiento correcto, la selección del vaso receptor y decidir el momento óptimo para la reconstrucción son los puntos más importantes a tener en cuenta. Por estos motivos consideramos que esta patología debe ser abordada en unidades de quemados multidisciplinares con personal altamente entrenado

BACKGROUND AND OBJECTIVE: Microsurgery as a technique in Plastic Surgery cannot miss any burn ut for complete treatmeent of their patientes. Especially in electric burns that have very serious lesions with exposure of noble tissues where Microsurgery is the first reconstructive option. The objective of this paper is to show the experience of the Burn Unit of the Vall d'Hebron University Hospital in Barcelona, Spain, over the last 10 years in the application of Microsurgery in the burned patient of electrical etiology. METHODS: A total of 19 flaps performed between January 2010 and August 2019 in patients with electrical burn injury were reviewed retrospectively. The data collected were sex, age, location of the defect, total burned surface area (TBSA), flap used, days until coverage, type of arterial anastomosis, number of veins used, flap survival and complications. RESULTS: It is noteworthy that all the 15 patients treated were male, with an average age of 36.5 years; average TBSA was 19.5%; the most frequently flap used was the antero-lateral thigh in 9 cases (47.37%), followed by the latissimus dorsi muscle in 4 cases (21.05%), the inguinal and the rectus femoris muscle in 2 cases each (10.53% in each case) and the thoraco-dorsal artery perforator and the superficial temporal fascia on 1 occasion each of them (5.26% in each case). The most frequent location was in the lower extremities in 12 cases (63.16%), followed by the upper extremities in 5 cases (26.31%) and the head in 2 cases (10.53%). On average, coverage surgery with the free flap was performed at 24 days. Arterial anastomosis was performed end-to-end in 15 cases (79%). The venous anastomosis was always end-to-end anastomosing 2 veins in 5 cases (26.31%) and only 1 in the rest (76.69%). Two flaps failed due to venous congestion (10.53%) and 2 flaps were complicated with infection (10.53%). CONCLUSIONS: The reconstruction of complex defects associated with an electrical burn has been, is a challenge for plastic surgeons because of the small number of cases that occur and, because of the idiosyncrasy of the electrical injury and the burned patient. A correct debridement, the selection of the recipient vessel and deciding the optimal time for reconstruction are the most important points to consider. For these reasons we believe that this pathology should be addressed in multidisciplinary burn units with highly trained personnel

Circumferential Partial-Thickness Burn Caused by Mobile Telephone Charger: A Case Report.

Many children and adolescents have access to portable electronic devices. Although not always the case, these devices are often charged at nighttime, especially while being used in bed. There are increasing media reports of electric current injury from the portable electronic devices' charging cables, particularly with equipment that is available for lower cost from generic manufacturers. A 19-year-old woman presented to the pediatric emergency department after a burn from her generic iPhone charger. She was lying in bed wearing a chain necklace, with the charger underneath her pillow and plugged into an electrical outlet, when she felt a sudden burning sensation and severe pain around her neck. She was found to have a circumferential partial-thickness burn. She underwent computed tomographic angiogram, whose result was unremarkable. The wound was debrided, and she was then discharged home. She likely sustained an electrical injury from the charger as it came in contact with her necklace, causing a burn. Several companies have investigated the difference in quality and safety of generic versus Apple-brand chargers and have found that the majority of the generic chargers fail basic safety testing, making them a higher risk for electrical injury. As a result of this case, patients and families should be educated about safe use of these devices, especially while they are charging.

Direct current electrical injuries: A systematic review of case reports and case series.

BACKGROUND: Direct current (DC) powered equipment and devices, including photovoltaic systems, high-voltage direct current power lines and novel concepts in electromobility have become increasingly popular in recent years. However, under adverse circumstances by malfunction or mishandling of these applications electrical injuries may occur when electric current passes through the human body. This review aimed at systematically summarizing the medical consequences of DC electrical injuries described in case reports and case series. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided the methodological conduct and reporting. RESULTS: Sixteen case reports and 3 case series were eligible for this review and included 70 patients. The reviewed articles were very heterogeneous regarding sources of DC electrical injuries and the reported medical consequences, including burns and skin lesions (n=67), neurological consequences (n=11), unconsciousness (n=10), cardiac consequences (n=8) and bone fractures (n=6). Seventeen individuals did not survive the electrical injuries. CONCLUSION: From the few available data and partly incomplete documentations of cases we could gather hints of DC medical consequences, however, it was not possible to identify well-defined medical consequences for various circumstances of DC electrical injuries in occupational and non-occupational settings. To achieve this goal, additional studies are required, each providing a comprehensive description of the medical consequences and the circumstances of the electrical injuries.

A Full-Thickness Burn in a Teenager Resulting from Prolonged Contact with a Mobile Phone Charging Cube: A Case Report.

We present a case of a teenager who suffered a full-thickness burn following prolonged contact with a mobile phone charging cube. The patient required primary surgical excision and closure of the wound resulting in a good clinical outcome. There have been multiple reports in the literature of burns resulting from lithium batteries; however, this appears to be the first case report of a full thickness burn resulting from a mobile phone charging cube. Given the ubiquity of mobile phone use among teenagers, primary care providers should warn patients about the risks of sleeping with an electronic device while it is connected to a charger.

Burn wounds after electrical injury in a bathtub: a case report.

BACKGROUND: Increased smartphone use among minors makes our population more prone to electrical injury. Despite regulations on electrical home safety standards, smartphones and chargers still pose a risk for severe injury among users. CASE PRESENTATION: We present a case of a patient with low-voltage electrical burns due to smartphone use in a bathtub. The 13-year-old Caucasian patient was using a smartphone plugged into the electrical grid while taking a bath. We report the burns and their treatment. We discuss the likely burn mechanism. CONCLUSIONS: Burn wounds after electrical injury due to smartphone use are rare. The presented case shows the danger of smartphone use in bathtubs.

Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors.

Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic.