Symptoms of Electric Burn

The symptoms depend on intensity of electricity causing burn.

Even the mildest electric burn needs urgent attention because it sometimes causes mild visible skin damage, but there can still be severe internal organ and tissue damage.

ECG, Blood and Urine examination give idea about the severity of internal damage.

There are some complications that require immediate attention and have serious on going effects in body which a Plastic surgeon should see and monitor closely. These complications include:

• Effect on kidney,Heart and muscles.
• Compartment syndrome of the involved extremity
• Ongoing progressive necrosis of muscles
• Gangrene

Sometimes the condition becomes so serious that it may also lead to Amputation and even death if not treated.

Different surgical procedures done to save the limb

1) Fasciotomy/ Debridement–

If hand and forearm swelling increases in due course, it can hamper the blood circulation of the limb, leading to compartment syndrome (increase pressure in muscles compartment). Urgent Fasciotomy is required in such cases

In this we give incision over forearm and hand, such that excess fluids and toxins are drained without disturbing the blood supply of the limb. In cases of electric burn, muscles of the forearm and hand are necrosedwhich are debrided along with fasciotomy.

Later patient may require furthermore debridement surgery to remove the unhealthy portion of the muscles.

After this, regular dressings are done daily.

After initial fasciotomy and debridement, Negative Pressure Wound Therapy (VAC) before definite procedure can be done to reduce the toxins and infection in the body.

Definite Procedure to close the wound are done last which may be skin grafting, flaps from abdomen or groin region or free flaps(microsurgical reconstruction) as per the requirement.

2) Skin grafting

Skin grafting is the transfer of thin skin sheet, usually taken from thigh, to cover the raw areas. Once the wound is healthy, skin grafting may be done if defect is not much deep and vitals structures are embedded in granulation tissue. In such cases, dressing is done every alternate day after surgery. Patient may be discharged after 5-6 days, and regular follow-up is required. The area gradually heals and need compression garment later to avoid hypertrophy of scars and to reduce the swelling.

3) Flaps from abdomen and groin

Flaps from groin, abdomen are very versatile flaps which can resurface the hands and forearm region. In this technique, the flaps from the groin, abdomen are used to resurface the defect while remaining attached via skin pedicle. This is a 2 staged procedure. In the first stage, flap is harvested from the selected area and the raw area is covered by Skin graft. In the second stage after 2- 3 weeks when the flap has restored its blood supply over the defect, it is detached from the abdomen or groin. Some amount of cosmetic deformity of the grafted abdomen or chest (area of the harvested flap) should be acceptable to the patient.

If not, or local flap fails, then a distant free flap is used to cover the defect through microvascular reconstruction.

4) Microvascular reconstruction

If defect is deep, any vital structures are visible, like blood vessels, nerve, bone or tendons exposed, then transfer of skin flap, muscle flap from a distant area as a free flap is done to cover the defect using microsurgical techniques. It needs surgical expertise and a good working team. Dr Amit Agarwal specializes in microsurgical reconstruction and has saved innumerable hands from amputation.

The flap should be monitored frequently post-surgery. Hospital stay is increased, but it is the best modality to cover the defects in electric burnpatients. Dressing is done every alternate day and patient is admitted for at least 7-8 days and discharged once the flap is settled.

All these surgical techniques are helpful at appropriate time, depending on the necrosis of muscles. Post-surgical management is equally important for overall outcome of the treatment.

After the surgery, patient is bedridden for 2-3 weeks. No ambulation is advised and limb has to be elevated by using pillows underneath. After several dressings, when the operated site is completely stable, patient is given pressure garments and ambulation is started.

Amputation

In untreated cases or neglected cases of electric burn, gangrene may occur, infection may lead to toxemia and septicemia i.e, release of toxins in the body by infectious organisms. Amputation may be required in such cases. In worst cases, even lead to death.

If a patient fails to reach the appropriate hospital or doctor for management of such cases on time, or due to other comorbidities, which decreases immunity of body, delay in healing occurs and infection spread much more quickly. In this scenario, patient might require amputation, which means it becomes imperative to remove the affected portion of the leg or arm from the body.

Post amputation when the stump completely settled, after about 2-3 months period, prosthetic limb is advised.

Three pillars of kayakriti