Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2016; 5(4): 228-234
Published online Nov 4, 2016. doi: 10.5492/wjccm.v5.i4.228
Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study
Aniruddh Mene, Gautam Biswas, Atul Parashar, Anish Bhattacharya
Aniruddh Mene, Gautam Biswas, Atul Parashar, Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Anish Bhattacharya, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Mene A contributed to the collection of data, organization of manuscript; Biswas G contributed to the conception and design of study, data analysis; Parashar A contributed to the conception and design of study, data analysis, manuscript preparation and review; Bhattacharya A contributed to data analysis and manuscript review.
Institutional review board statement: The format of study was reviewed and approved by the Ethics Committee/Institutional Review Board duly constituted for clinical study at Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
Informed consent statement: All study participants, or their legal guardian were explained in their own language about the inclusion in the study. Informed written consent was duly taken prior to enrollment in the study.
Conflict-of-interest statement: None of the authors have any conflicts of interests to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Atul Parashar, Associate Professor, Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. atulparashar@hotmail.com
Telephone: +91-172-2756792
Received: April 20, 2016
Peer-review started: April 22, 2016
First decision: June 6, 2016
Revised: July 19, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: November 4, 2016
Processing time: 196 Days and 20.7 Hours
Abstract
AIM

To look into the management options of early debridement of the wound, followed by vascularized cover to bring in fresh blood supply to remaining tissue in electrical burns.

METHODS

A total of 16 consecutive patients sustaining full thickness forearm burns over a period of one year were included in the study group. Debridement was undertaken within 48 h in 13 patients. Three patients were taken for debridement after 48 h. Debridement was repeated within 2-4 d after daily wound assessment and need for further debridement.

RESULTS

On an average two debridements (range 1-4) was required in our patients for the wound to be ready for definitive cover. Interval between each debridement ranged from 2-18 d. Fourteen patients were provided vascularized cover after final debridement (6 free flaps, 8 pedicled flaps). Functional assessment of gross hand function done at 6 wk, 2 mo, 3 mo and 6 mo follow-up.

CONCLUSION

High-tension electrical burns lead to significant morbidity. These injuries are best managed by early decompression followed by multiple serial debridements. The ideal timing of free flap coverage needs further investigation.

Keywords: Early debridement; Vascularized cover; Electrical burns; Forearm

Core tip: High-voltage electrical injuries lead to be a significant morbidity associated with severe socioeconomic implications. There is conflicting evidence in the literature regarding progressive tissue necrosis in this devastating injury. We looked into the management options of early debridement of the wound, followed by vascularized cover to bring in fresh blood supply to remaining tissue, which can potentially prevent further progression of this pathology. We found that the phenomenon of ongoing necrosis was not halted in our study and all our early flaps failed to ingress the blood flow to the so-called ischemic zone post trauma. Electrical injuries were progressive in nature and required multiple radical debridement until the wound is ready for definitive cover.