[Early treatment of high-voltage electric burn wound in the limbs]

Abstract

Objective: To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs.

Methods: Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up.

Results: Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture.

Conclusions: Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.