857 Reconstruction of the Pediatric Upper Extremity Following High Voltage Electrical Burn Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S266-S267
Author(s):  
Matthew A Depamphilis ◽  
Ryan Cauley ◽  
Farzin Sadeq ◽  
Robert Sheridan ◽  
Daniel N Driscoll
Keyword(s):  
Upper Extremity ◽  
High Voltage ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Multidisciplinary Treatment ◽  
Small Surface ◽  
Term Function ◽  
Electrical Burns ◽  
Electrical Injuries

Abstract Introduction High voltage electrical burns are often associated with significant morbidity, posing great acute and delayed reconstructive challenges for plastic surgeons. As survival from these injuries increases, attention has been focused on improving quality of life post burn injury through restoration of sensory and motor function. However, due to the complexity of the upper extremity and its small surface area in pediatric patients, its reconstruction can be a very complex endeavor. Especially in pediatric patients that are still growing, ensuing great risk for upper extremity contracture and deformity. Methods A retrospective chart review was conducted on patients aged 0–18 years admitted to our institution with a high voltage electrical burn involving the upper extremity. The timeframe under study was 13 years from January 1st 2005 to December 1st 2018. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board. Results Out of the 68 electrical burns treated at our pediatric burn center, 58 involved the upper extremity. This further divides into 37 patients with high voltage and 31 patients with low voltage upper extremity electric burns. Of the 37 high voltage upper extremity patients, 35 underwent acute surgical management and 18 had delayed surgical reconstruction for the upper extremity. Conclusions The reconstructive techniques employed at our institution following severe electrical injuries typically follow a reconstructive ladder. The majority of chronic contractures in our series were successfully treated with either minimally invasive techniques such as laser and steroid infiltration, local tissue flaps, or release and skin grafting. Applicability of Research to Practice Multidisciplinary treatment of severe electrical injuries to the upper extremity is vital to optimizing a patient’s long-term function. Given the significant depth of injury in cases of electrical burns to the upper extremity the risk of developing contractures is relatively high. The expeditious treatment of secondary contractures is important to maximize a patient’s long-term function. The general treatment of contractures of the upper extremity should be based on the location and severity of the contracture, with considerations made for the patient’s reconstructive goals.

561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S130-S131
Author(s):  
Andrew Khalifa ◽  
Anzar Sarfraz ◽  
Jacob B Avraham ◽  
Ronnie Archie ◽  
Matthew Kaminsky ◽  
...  
Keyword(s):  
Case Report ◽  
High Voltage ◽  
Troponin I ◽  
Low Voltage ◽  
Foley Catheter ◽  
The United States ◽  
Upper Extremities ◽  
Full Thickness ◽  
Electrical Injuries

Abstract Introduction Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes. Methods This case-report was conducted via retrospective chart review of the case presented. Results A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital. Conclusions Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.

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

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S158-S158
Author(s):  
Harold Campbell ◽  
Rabia Nizamani ◽  
Samuel W Jones ◽  
Bruce Cairns ◽  
Felicia N Williams
Keyword(s):  
Public Health ◽  
Upper Extremity ◽  
High Voltage ◽  
Health Problem ◽  
Public Health Problem ◽  
Online News ◽  
Voltage Transformer ◽  
News Reports ◽  
Burn Center ◽  
Electrical Burns

Abstract Introduction The art of pyrography, creating designs in wood with a thermal heat source, dates back to prehistory. Risks include cutaneous burns and airway injury. Fractal woodburning is a niche method of pyrography utilizing a high-voltage electrical source to burn branched designs – Lichtenberg patterns – into the surface of wood. While this technique has grown in popularity, the associated risks are not well described. Methods We describe a patient who presented to our burn center after sustaining high-voltage electrical burns from a homemade high-voltage device constructed for fractal woodburning. We also evaluated publicly reported cases of death or injury due to this technique. Results An otherwise healthy 17-year-old male was admitted to our burn center with injuries sustained while making fractal wood art. The patient improvised a high-voltage transformer from a discarded microwave, generating 2000 volts from household current. While using this device to burn Lichtenberg patterns in wood, he contacted the electrodes and sustained full-thickness electrical burns to the neck, chest, and bilateral upper extremities. Bilateral upper extremity fasciotomies were required on admission. Multiple subsequent operative procedures culminated with autografting to the majority of the wounds and ongoing complex reconstruction of the left thumb. In evaluating online news reports, we found 21 unique individuals with death or injury attributed to fractal woodburning. Four sustained substantial injuries, while 17 reportedly died. The first reported incident occurred in July 2016 and the most recent report was from July 2019. Ages ranged from 17 years old to the 60s. Eighteen individuals were younger than 50 years old. All of the mortalities and 3 of the 4 injuries occurred in males. Of the survivors, 3 sustained significant upper extremity injuries and 2 suffered cardiac arrest at the time of injury. The devices used in 4 incidents were microwave transformers and generated 2000 volts. Device characteristics were not identified in the remainder of cases. Conclusions Fractal woodburning is associated with devastating high-voltage electrical injuries and death. Prevention efforts should be focused on the potential risks of this art form. Applicability of Research to Practice News reports likely underestimate the actual incidence of injury and death due to fractal woodburning, however, even this limited data suggests an emerging public health problem requiring further study and public education.

Use of the Pedicled Tensor Fascia Lata Myocutaneous Flap in the Salvage of Upper Extremity High-Voltage Electrical Injuries

2010 ◽  
Vol 31 (4) ◽  
pp. 670-673 ◽  
Author(s):  
Grant Fankhauser ◽  
Aaron Klomp ◽  
Anthony Smith ◽  
Alanna Rececca ◽  
William Casey
Keyword(s):  
Upper Extremity ◽  
High Voltage ◽  
Myocutaneous Flap ◽  
Fascia Lata ◽  
Tensor Fascia Lata ◽  
Electrical Injuries

Patterns and outcomes of high-voltage versus low-voltage pediatric electrical injuries: an 8-year retrospective analysis of a tertiary-level burn center

2021 ◽  
Author(s):  
Kayhan Gurbuz ◽  
Mete Demir
Keyword(s):  
High Voltage ◽  
Parental Education ◽  
Burn Injury ◽  
Low Voltage ◽  
Total Body Surface Area ◽  
Power Lines ◽  
Age Group ◽  
Voltage Versus ◽  
Burn Center ◽  
Electrical Injuries

Abstract Introduction Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage (HVI) vs. low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. Methods A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital (ACTRH) for eight years (2013-2020). Data including the patients’ clinical and demographic characteristics, the percentage of total body surface area with burns (TBSA%), length of hospital stay (LOS), exposure place, electrical current type, and treatment results were collected and analyzed. Results EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13-18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, with a lesser extent in LVIs, in the home environment among children under five years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of TBSA%, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HV and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full thickness burns were more prevalent among the HVIs. The amputation rate was 12% which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated CK and CK-MB levels than LVIs but were not correlated with ECG findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Conclusion Pediatric EIs are less common than scald or fire-flame related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

scholarly journals Long-term oxandrolone treatment increases muscle protein net deposition via improving amino acid utilization in pediatric patients 6 months after burn injury

Surgery ◽  
2011 ◽  
Vol 149 (5) ◽  
pp. 645-653 ◽  
Author(s):  
Demidmaa Tuvdendorj ◽  
David L. Chinkes ◽  
Xiao-Jun Zhang ◽  
Oscar E. Suman ◽  
Asle Aarsland ◽  
...  
Keyword(s):  
Amino Acid ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Muscle Protein ◽  
Amino Acid Utilization

scholarly journals Bilateral maculopathy following electrical burn: case report

2014 ◽  
Vol 132 (6) ◽  
pp. 372-376 ◽  
Author(s):  
Leandro Dario Faustino ◽  
Ramon Antunes Oliveira ◽  
Andrea Fernandes Oliveira ◽  
Eduardo Büchelle Rodrigues ◽  
Nilva Simeren Diego Moraes ◽  
...  
Keyword(s):  
Case Report ◽  
Retinal Detachment ◽  
High Voltage ◽  
Surgical Approach ◽  
Multidisciplinary Treatment ◽  
Posterior Segment ◽  
Eye Injuries ◽  
Multiple Organs ◽  
Electrical Burns ◽  
Socioeconomic Cost

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed.CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity.CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns.

scholarly journals Magnitude of electric burns at a burn center in tertiary level hospital

2019 ◽  
Vol 51 (1-2) ◽  
pp. 29-34
Author(s):  
Md Tarikul Islam ◽  
Mizanur Rahman ◽  
SM Zulker Nayeem ◽  
Md Farid Uddin
Keyword(s):  
Functional Disability ◽  
Burn Injury ◽  
Electrical Power ◽  
Length Of Hospital Stay ◽  
Public Health Problem ◽  
Burn Injuries ◽  
Secondary Contact ◽  
Electrical Burns ◽  
Electric Burns ◽  
Electrical Injuries

Background: Burns are a public health problem throughout the world. Electrical injury is a major cause of burn injury which causes significant functional disability, disfigurement and mortality. In Bangladesh, the number of electrical injuries are increasing but they are typically underreported. Aims: This study was conducted to analyze the epidemiological variables of electrical burn injuries and identify preventable measures through them in Khulna region of Bangladesh. Methods: This descriptive study is a prospective analysis of patients suffering from electrical burns admitted at Burn and plastic surgery department from July 2017 to June 2018. The study population consists of 68 patients who sustained electrical injuries irrespective of age and time with cutaneous burns, admitted at this Center. Patients with electrocution but no electrical cutaneous burn injuries were excluded from this study. Results: Majority were males (77.94%) of working age and injuries were work related (52.94%) of which 32.36% were construction workers. The primary cause in majority of the cases (57.35%) was accidental direct contact with electric wire followed by secondary contact with electrical power lines by metal rods and electrification of different metallic equipments (42.64%). Most of the patients admitted were high voltage electrical injuries (54.42%). Among them 16.17% had severe electrical burns and 2.94% had associated traumatic injuries. There was a delay in time of injury to hospital admission, 35.29% arrived at the emergency room 8 or more hours after the injury. Most (63.24%) of the patients underwent surgery, majority of which had moderate to severe burns. Length of hospital stay was 3-102 days. Two patients (2.94%) died during this study period due to renal failure and septicaemia. Conclusion: Most of the electric burn patients acquired injury at working place and primary cause was direct or secondary contact with powerline. Immediate preventive measures should be taken to reduce the incidence of electric burns. Bang Med J (Khulna) 2018; 51 : 29-34

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