Limb Gangrene Following High Tension Electrical Injury: The Need For Caution!

摘要

BACKGROUND: High tension electrical injuries are uncommon in our society. They usually occur accidentally and often occupational. Resulting injuries which can be severe may lead to limb gangrene and subsequent amputation.METHODS: Two cases of high tension electrical injuries which resulted in limb gangrene and eventual amputation are presented and prevention strategies highlighted. Case 1 was a 12 year old student who had gangrene of both feet and Case 2 was a 48 year old right handed electricity worker who sustained gangrene of his right hand following electrocution at work. Both patients were treated by limb amputation at various levels.CONCLUSION: Gangrene treated by limb amputation may complicate high tension electrical injuries. There is need for caution to prevent this cause of loss of limb. INTRODUCTION Electrical injuries have become a more common form of trauma with a unique pathophysiology and with high morbidity and mortality. They consist of several types: lightning injury 1, high-voltage injury (>1000 volts), and low-voltage injury (< 1000 volts).2,3,4 High tension electrical injury is usually accidental. Generally, high voltage is associated with greater morbidity and mortality, although fatal injury can occur at household current (110 volts). Clinical manifestations range from transient unpleasant sensations without apparent injury to massive tissue damage. 5 Up to 40% of serious electrical injuries are fatal. 2,3,4 Electric current may be retained in the bones, causing heat and leading to necrosis and coagulation of small- to medium-sized vessels within the muscles and other tissues, almost completely sparing the skin. Blood vessels and muscles of the limb may also be affected leading to limb gangrene which is relatively uncommon6. Amputation is usually indicated in these cases. An epidemiological study of 383 cases in China underscores the need for stronger preventive measures.7Appropriate knowledge of the mechanisms of injury and the principles of therapy improves patient care.8 It is essential to remember that the superficial appearance of an electrical burn may underestimate the degree of underlying tissue destruction. With electrical injuries the thought in regard to damaged extremities is to favour early and aggressive surgical management including early decompressive escharotomy, fasciotomy, carpal tunnel release or even amputation of an obviously nonviable extremity.9,10,11,12In view of the limitation of function that usually results and the negative perception of amputation, it is imperative that all measures be instituted to prevent these injuries. Two cases of limb amputation following gangrene resulting from high tension electrical injury is reported to emphasize the need for caution as a preventive strategy. CASE REPORTS A 12 year old female, Primary School pupil, stepped on a high tension electrical wire that had cut and fallen to the ground the previous day following an episode of heavy rain storm. She was electrocuted and fell to the ground, sustaining extensive burns of both upper and lower limbs; and her trunk. Subsequently, she became unable to bear weight on both lower limbs. The toes of her right foot and the 1st and 2nd toes of her left foot later became dusky in colour and then frankly black.She was taken to a nearby hospital where she was given initial treatment before referral to our centre. On presentation, she was in painful distress, pale, febrile, with extensive superficial and deep burns affecting her upper and lower limbs with black discolouration of the all toes of her right foot and 1st and 2nd toes of her left foot.She was resuscitated, appropriate investigations done and wounds dressed daily. She had open right Lisfranc’s amputation and ray amputation of left 1st and 2nd toes. Escharectomy and eventually split thickness skin grafting of the burns area was done with good outcome. The amputation stumps were closed and wounds healed satisfactorily.CASE 2A 48 year old male, right