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      Early Coverage of Upper Extremity Electrical Injury Wounds

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          Abstract

          Background

          An appropriate and well-timed surgery has great impact on a patient’s treatment and can prevent further damage to partially injured structures which if untreated will be lost leading to severe disability. In the present study we report our experience with early coverage of electrically injured upper extremity vital structures with encouraging results.

          Objectives

          The aim of this study was to evaluate the results of early flap coverage (less than two weeks) after electrical injury in the induced wounds of upper extremity.

          Materials and Methods

          The records of electrically injured patients referred during a 10- year period to Firuzgar Medical Center were evaluated. After one or two sessions of debridement, the wounds were covered by distant or pedicled flaps and the results were evaluated according to the number of surgeries, complications and return to work time.

          Results

          Thirty patients were registered in this study, mean age at the time of injury was 26.43 (SD = 10.41) years; 40% of patients had right upper extremity injury, 23.3% had left and 36.7% had bilateral injury. 43.4% of patients had no complications, amputation rate was 23.3% and nerve injury was seen in 13.3% of patients. Mean days of return to work was 132.57 (SD = 64.99). In 11 patients distant flaps were used, 9 patients with graft only and 7 patients had a combination of graft and regional flaps.The dominant hand involvement in electrical injury is very high.

          Conclusions

          We suggest that the routine treatment protocols of serial debridement until all the wound acquires a bed of granulation tissue should be revised, because the vital structures such as tendons and nerves will have undergone dessication necrosis and a young worker will be crippled for life. Early coverage of partially injured vital structures is gaining acceptance and this paper confirms the above mentioned treatment protocol.

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          Most cited references11

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          Narrative review: Electrocution and life-threatening electrical injuries.

          The authors reviewed the mechanisms and pathophysiology of typically encountered electrical injuries by searching English-language publications listed in MEDLINE and reference lists from identified articles. They included relevant retrospective studies, case reports, and review articles published between 1966 and 2005. The authors also searched the Internet for information related to electrocution and life-threatening electrical injuries. They found that familiarity with basic principles of physics elucidates the typical injuries sustained by patients who experience electrical shock. Death due to electrocution occurs frequently. However, patients successfully resuscitated after cardiopulmonary arrest often have a favorable prognosis. Approximately 3000 patients who survive electrical shock are admitted to specialized burn units annually. Patients with serious electrical burns admitted to the intensive care unit are trauma patients and should be treated accordingly. Initial prediction of outcome for patients who have experienced electrical shock is difficult, as the full degree of injury is often not apparent.
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            Electrical and lightning injuries.

            Electricity and lightning can cause injury in a variety of ways, some of which may remain hidden from the unsuspecting physician until it is too late. Prompt and, if necessary, prolonged resuscitation are of proven benefit. Particular attention must be paid to the patient who suffers high-voltage injury, and deep electrothermal burns on damage to vital organs should be excluded. Uncommonly late sequelae are seen, and such patients require appropriate care.
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              Electrocution-related mortality: a review of 123 deaths in Diyarbakir, Turkey between 1996 and 2002.

              Electrical burns are responsible for considerable morbidity and mortality, and are usually preventable with simple safety measures. We conducted a retrospective study of non-lightening electrocution deaths in Diyarbakir, Turkey between 1996 and 2002. All 123 deaths investigated were accidental. The age range was 2 to 63 years with a mean age of 20.7 +/- 15.3 years. Eighty-six victims (69.9%) were male. The upper extremity was the most frequently involved contact site in 96 deaths (48%). No electrical burn mark was present in 14 (11.4%) cases. Home accidents were responsible for 56 cases deaths (45.5%). Deaths were caused most frequently by touching an electrical wire (52 cases, 42.3%). There was an increase in electrocution deaths in the summer (47 cases, 38.2%). One hundred one cases (82.1%) were dead on arrival at hospital. The unique findings of our study include younger age (0-10 years) of victims (39 cases, 31.7%) and a means of electrocution (electrical water heaters in bathroom) in 23 cases (18.7%). Rate of deaths due to electrocution among all medicolegal deaths was found higher in our study than in previous studies. The public should be educated to prevent children to play near electrical appliances and to avoid electrical heaters in the bathroom.
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                Author and article information

                Journal
                Trauma Mon
                Trauma Mon
                10.5812/traumamon
                Trauma Research Center
                Trauma Monthly
                Trauma Research Center
                2251-7464
                2251-7472
                10 October 2012
                Autumn 2012
                : 17
                : 3
                : 333-336
                Affiliations
                [1 ]Department of Surgery, Firouzgar Hospital, Tehran, IR Iran, Tehran, IR Iran
                Author notes
                [* ]Corresponding author: Shahram Nazerani, Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2122541429, Fax: +98-2122541429, E-mail: snazerani@ 123456yahoo.com
                Article
                10.5812/traumamon.6971
                3860623
                940f1f48-1c38-4a32-b74a-effad3ffff52
                Copyright © 2012, Kowsar Corp.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 July 2012
                : 25 June 2012
                : 23 July 2012
                Categories
                Research Article

                electric injuries,reconstructive surgical procedures,free tissue flaps

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