Is Immediate Decompression of High Voltage Electrical Injuries to the Upper Extremity Always Necessary?

Mann, Roberta; Gibran, Nicole S.; Engrav, Loren H.; Heimbach, David M.

doi:10.1097/00005373-199604000-00011

Cited by 65 publications

(13 citation statements)

References 15 publications

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“…Delayed exploration and decompression in the compromised extremity, however, may result in increased amputation rates along with increased organ failure and mortality. 31 Process A Medline search from 1966 to the present was used to evaluate monitoring and the need for early exploration and fasciotomy in electrical injury to the extremity. A search for the key words, "electrical injury," "fasciotomy," "compartment syndrome," "compartment pressure," "Doppler flow meter," "technetium 99m pyrophosphate," "infrared photoplethysmography," and "burn injury" was performed, and relevant articles were reviewed.…”

Section: Clinical Problemmentioning

confidence: 99%

Practice Guidelines for the Management of Electrical Injuries

Arnoldo

Klein

Gibran

2006

Journal of Burn Care & Research

105

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Section: Clinical Problemmentioning

confidence: 99%

Practice Guidelines for the Management of Electrical Injuries

Arnoldo

Klein

Gibran

2006

Journal of Burn Care & Research

105

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“…We do not provide a discussion on the physics of electrical current or overall management of electrical injuries. These have been well reviewed elsewhere 4, 33-35 . Our study is prone to chronology bias 36 , where secular trends in medical care may change the standard of medical care.…”

Section: Discussionmentioning

confidence: 99%

Temporal Changes in Deep Venous Thrombosis Risk After Electrical Injury

Pannucci

Diaz

Wahl

2011

Journal of Burn Care & Research

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Introduction Previous work has utilized the National Burn Repository to examine deep venous thrombosis (DVT) after electrical injury. However, these studies were limited and could not examine when DVT occurs after electrical injury. In addition, the utility of risk assessment models for DVT risk stratification has not been examined in this patient population. Methods We performed a retrospective chart review of electrically injured patients at a single, ACS-verified burn center over a nine year period. Risk factors were identified and used to calculate Caprini scores at baseline and time of discharge. Outcomes of interest included symptomatic DVT or pulmonary embolus (PE) and time to DVT or PE. Results A total of 77 electrically injured patients were identified. DVT incidence was 6.5%. Patients with DVT had significantly higher TBSA (27.8% vs. 3.8%), mean number of operations (4.8 vs. 0.3), central venous catheter insertion (100% vs. 5.3%), ventilator days (16.2 vs. 0.3), ICU days (24.4 vs. 0.9), and mean change in Caprini score (18.6 vs. 1.3) during hospitalization. Baseline Caprini scores were low and DVT events occurred only after multiple risk factors were present; the average time-to-event was hospital day 17. Among patients with Caprini score >8, DVT incidence increased to 62%. Conclusions In our single center experience, the Caprini score was able to quantify DVT risk after electrical injury. In our series of 77 patients, the overall incidence of DVT was 6.5%. However, among patients whose Caprini score reached >8 during hospitalization, DVT incidence increased to 62%.

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Section: Discussionmentioning

confidence: 99%

“…Although, some studies advocate an immediate decompression[8], this concept has been questioned by others[9]. Mann et al[9] advocated selective decompression only in the presence of signs of compartment syndrome. They have based their algorithm on a continuous clinical evaluation and they opine that selective, non-immediate decompression may preserve tissue thus contributing to lower amputation rates.…”

Section: Discussionmentioning

confidence: 99%

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Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study

Menè

Biswas

Parashar

et al. 2016

WJCCM

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AIMTo 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.METHODSA 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.RESULTSOn 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.CONCLUSIONHigh-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.

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Is Immediate Decompression of High Voltage Electrical Injuries to the Upper Extremity Always Necessary?

Cited by 65 publications

References 15 publications

Practice Guidelines for the Management of Electrical Injuries

Practice Guidelines for the Management of Electrical Injuries

Temporal Changes in Deep Venous Thrombosis Risk After Electrical Injury

Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study

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