Electrical burn injuries. Some unusual clinical situations and management.

A retrospective and prospective management of 665 patients of electrical burn injuries out of 10,000 burn cases admitted between 1996 and 2004 (9 years) was analyzed. The problems encountered and their solutions are presented. One hundred and fifty-five (155) of them had their limbs amputated, i.e. (24%). The pathophysiology of electrical injury is reviewed. Serial and multiple debridement of wounds were performed, preserving the nerves, tendons, joints and bones even if denatured to preserve the continuity as these could regenerate partially if covered with vascularised skin. Functional outcome of an electrical burn wound is inversely proportional to the time lapsed before start of reconstructive procedure/s. Infrastructural limitations like severe shortage of blood, and surgical materials due to a disparity between demand and supply added to the poor general condition of the patient unfavorably delayed the start of reconstruction and precipitated "an unusual clinical situation". The aim of management has been to obtain a healthy wound, which could support an inset of a skin edge. Under these situations, a stable wound was obtained on the 12th day [average]. Split skin grafts and loco-regional flaps, using time-old principles of rotation, advancement, transposition served well in most of our cases. Through this paper, some unusual wounds in unusual clinical situations, which were managed with various methods of reconstruction, following the reconstructive ladder are presented.