Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Epidemiology of electrical burns and its impact on quality of life-the developing world scenario

BACKGROUND Electrical burns are devastating injuries and can cause deep burns with significant morbidity and delayed sequelae.Epidemiological data regarding the etiology,socioeconomic differences and geographic variation are necessary to assess the disease burden and plan an effective preventive strategy.These severe injuries often lead to amputations and thus hamper quality of life in the long term AIM To identify the population at maximum risk of sustaining electrical burns.We also studied the impact of electrical burns on these patients in terms of quality of life as well as return to work.METHODS The study was conducted at a tertiary referral teaching hospital over a period of eighteen months.All patients with a history of sustaining electrical burns and satisfying the inclusion criteria were included in the study.All relevant epidemiological parameters and treatment details were recorded.The patients were subsequently followed up at 3 mo,6 mo and 9 mo.The standardized Brief Version of the Burn Speci
c Health Scale(BSHS-B)was adopted to assess quality of life.Statistical analysis was conducted using IBM SPSS statistics(version 22.0).A P value of<0.05 was considered statistically significant.RESULTS A total of 103 patients were included in the study.The mean age of the patients was 31.83 years(range 18-75 years).A significant majority(91.3%)of patients were male.The mean total body surface area(TBSA)in these patients was 21.1%.In most of the patients(67%),the injury was occupation-related.High voltage injuries were implicated in 72.8%of patients.Among the 75 high voltage burn patients,31(41%)required amputation.The mean number of surgeries the patients underwent in hospital was 2.03(range 1 to 4).The quality of life parameters amongst the patients sustaining high voltage electrical burns were poorer when compared to low voltage injuries at all follow-up intervals across nine domains.In eight of these domains,the difference was statistically significant.Similarly,the scores among the amputees were poorer when compared to non-amputees.The difference was statistically significant in six domains.CONCLUSION Electrical burns remain a problem in the developing world.Most injuries are occupation-related.The quality of life in patients with high voltage burns and amputees remains poor.Work resumption was almost impossible for amputees.These patients could not regain pre-injury status.Steps should be taken to create awareness and to implement an effective preventive strategy to safeguard against electrical injuries.

Perineal Electric Burn Reconstruction Using Modified Thoraco-Umbilical Flap

Perineal reconstruction is an essential component of the overall treatment plan of perineal electric burn, but it is a very difficult and complex job. The modified thoraco-umbilical flap may be a perfect way of repairing perineal area. It is based on the deep inferior epigastric artery and vein and the superior epigastric artery and vein, which look like the “reverse TRAM flap”. The large flap could be fashioned into a perfect perineal area without the need for free flap. It left a satisfactory donor scar, and it avoided the need to change the patient’s position during the operation. Four cases were reconstructed by modified thoraco-umbilical flap after perineal electric burn, and all of them were satisfied with the results. The modified thoraco-umbilical flap has been emerged as a very useful reconstructive tool and is particularly valuable in reconstruction of the perineal electric burn.