- See: Burn Management:
- Discussion:
- these burns are always much worse than they appear, and the big mistake is to underestimate their severity;
- deeper tissues receive more damage and burn injury than superficial tissues;
- consider using arteriography to help determine zone of injury;
- extent of injury to proportional to:
- amount of current - volatage/resistance;
- resistance (least: nerve, vessel, muscle, skin, tendon, fat, bone)
- types of current:
- AC current (more dangerous, esp slow AC)
- produces muscular tetany
- patient frozen and cant withdraw
- Surgical Considerations:
- compartment syndrome: occurs frequently;
- debridement:
- preop planning should give an idea of the amount of debridement required (either by using
arteriography or MRI to determine the zone of injury);
- myoglobinuria is an indicator that significant muscle necrsosis is present;
- soft tissue coverage:
- early free flap reconstruction may be useful w/ severe injuries;
- references:
- A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient.
- Proceedings of the NIH Conference: Advances in Understanding Trauma and Burn Injury: Session IV: Wound Healing: Current Status of Skin Replacements for Coverage of Extensive Burn Wounds.
- Selection of topical antimicrobial agents for cultured skin for burns by combined assessment of cellular cytotoxicity and antimicrobial activity.
- Treatment of severe burns with widely meshed skin autograft and meshed skin allograft overlay.
- Early adipofascial flap coverage of deep electrical burn wounds of upper extremities.
- Early free-flap coverage of electrical and thermal burns.
- Complications:
- cardiac arrhythmias
- renal failure
- secondary to myoglobinuria);
- sedondary to underestimation of fluid requirements;
- sepsis
- neurological (brain, spinal cord, peripheral)
- secondary hemorrhage
- cataracts
- Outside Links:
- First Aid Manual - 1
- First Aid Manual - 2
- Iowa Family Practice Handbook
- Merck Manual
Early free-flap coverage of electrical and thermal burns.
Surgical correction of postburn flexion contractures of the fingers in children.
Results of early excision and grafting in hand burns.
Early adipofascial flap coverage of deep electrical burn wounds of upper extremities.