Elsevier

Burns

Volume 24, Issue 7, November 1998, Pages 649-653
Burns

Factors influencing the sequelae of high tension electrical injuries

https://doi.org/10.1016/S0305-4179(98)00082-5Get rights and content

Abstract

The purpose of this study was to conduct a retrospective analysis of the clinical spectrum, treatment and morbidity of the patients who have suffered high tension electrical injuries with current passage through their body (59 patients). Voltage, localization and surgical treatment seem to be the main factors influencing the lesion and the morbidity. The following points were considered: (1) Is there any relation between known factors such as voltage and the localization of the points of contact with the incidence and the type of complications and sequelae? (2) Do the observations show that wound management and the excision of dead tissues is the most adequate? From factors studied in our patients (voltage, point of entry and pathway of current, associated multiple trauma or flame burns, surgical treatment) we have found that the voltage does not have any influence on the severity of the wound nor on the percentage of sequelae (cataracts, limb amputation, neurologic complications). The current pathway, as well as its points of entry, does not show any relation with the presence of renal failure, cardiac arrhythmia and cataracts. A clear relationship between the point of entry of the current and the appearance of neurologic injury with presence of paralysis and permanent regional anaesthesia at the same level was observed. The presence of associated burns was not related to any other complications or sequelae. For those patients whose length of contact has been shorter we find a lower rate of amputations despite having associated limb fractures. Fasciotomy incisions appear to confer benefit as this series shows that this procedure decreases the rate of limb amputations.

Introduction

The clinical spectrum of electrical injuries is complex and varied. Multiple interacting variables including voltage, amperage, tissue resistance, tissue susceptibility, type of current, current pathway, site and size of electrical contact and electrical density determine the severity and distribution of the injury[1]. A distinction between low and high tension current is made at 1000 volts. Typically, high tension electrical injuries cause destruction at the point of contact with massive necrosis of deeper structures. There is also damage along the current pathway through the different tissues. An analysis of this unit's experience with high tension electrical injuries has been performed. Cardiac arrhythmia, acute renal failure and neurologic complications are expected in these patients. Specific sequelae such as cataracts, limb amputation and neurological deficits are major contributors to the high morbidity of high tension electrical injuries. The relationship between factors influencing the severity of the initial injury, such as voltage, points of contact and current pathway, and the occurrence of complications (renal failure, cardiac arrhythmia) or sequelae (amputation, neurologic and ophthalmologic sequels) has not been clearly presented in the literature. The purpose of this study is to determine the influence of these factors on the treatment and outcome of this type of injury.

Section snippets

Clinical data

A retrospective analysis of the patients who suffered high tension electrical injuries during the last eleven years (1986–1996) has been carried out. In this period 1,557 burn patients have been treated in our Hospital. Fifty-nine patients suffered from high tension electrical burns (equal or above 1,000 volts) with passage of current flow through the body. These patients account for 3.7% of the burns treated in our hospital and 7% of the burns treated in our Burns Unit. 80% were male patients,

Discussion

In our series, the mean third degree BSA was 6% for those patients without an associated flash injury or flame burns, whereas the mean percentage in other series of patients with electrical injuries ranges from 8 to 24%3, 4, 5, 6. The surface area burn usually results from an associated flash injury or flame burn. From our experience we consider that the complications and sequelae depend more on the total body mass injury (muscular necrosis, tendinous, osseous), parameters which are highly

Conclusions

After studying several factors likely to influence severity and outcome of high voltage electrical injuries (voltage, points of contact, pathway of current) we conclude that the voltage is not related to the occurrence of complications (acute renal failure, cardiac arrhythmia), nor with the incidence of sequelae (cataracts, amputations, nervous injury). A higher voltage does not mean a higher lesion severity. Probably the length of the contact is an important determining factor but this is

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