SUMMARY. Between January 1979 and January 1987, 125 patients were treated in our centre as a result of electrical injuries.
Of these, 85 patients were over 15 years old (89.4% males and 10.6% females) and 40 patients were under 15 years old (92.5% males and 7.5% females).
The occupation of the over 15 years old group was mainly that of electrician, and of student in the under 15 years old group. Besides systemic and surgical treatment, 5 of our 6 multiple trauma patients were rehabilitated through physical therapy and prothesis and have returned to their occupation in society.

Human life and socio-economical activity have changed rapidly since the use of electrical energy has spread all over the world. In our country, electrical energy is used widely, but improperly, and because of this the incidence of electrical injury is high, causing .many severe complications or death (3). This paper will cover our experience with severe electrical injury.

Fig. 1 Fig. 2

Fifty-two (44%) of the patients were injured with domestic electric current (220-400 volts) and 62 (44.68%) were injured with high-tension (1,000-38,000 volts).
The occupations of patients over 15 years were as follows: 36 (42.35%) electricians, 20 (23.5%) bluecollar workers, 9 (10.58%) farmers, 7 (8.23%) housewives, 6 (7%) teachers, and 7 (8.23%) others, including 2 students, 2 chauffeurs, 1 pharmacist, 1 retired person and 1 shoemaker (Fig. 3).

Fig. 3

A.Y., 26 years old male (farmer): electrical accident with high voltage 3 extremities 26% 2nd-3rd T.B.S.A.
D.D., 32 years old male (teacher): accident With high voltage 3 extremities 18% 2nd-3rd T.B.S.A.
S.B., 18 years old female (secretary): accident high voltage 3 extremities 10% 2nd-3rd T.B.S.A.
G.S., 26 years old female (teacher): accident high voltage 3 extremities 9.5% 2nd-3rd T.B.S.A.
M.S., 23 years old male (blue-collar worker): accident high voltage 4 extremities 33% 3rd T.B.S.A.

All of our patients came to our centre from throughout Turkey, with no seasonal statistical difference in incidence of injury.
The treatment of all patients began at the time of hospitalization. Following a routine examination, IV fluid (Saline or Saline with dextrose) was administered, and following the results of the electrolyte meaArements, provided potassium levels were normal, the solution was changed to Ringer's lactate. The rate of administration was adjusted according to urine output of at least 50 nil per hour. If the patient was oliguric and acidotic, sodium bicarbonate, 20-40 gm of mannitol, and 40-100 mg furosemide were given. If the patient still remained oliguric, and potassium, BUN and creatinine levels were rising, peritoneal or haemodialysis using a double lumen subclavian catheter (Gambo SCK-102 20 cm, Lund, Sweden) was resorted to. We found that this system was very easy to use for both haemodialysis and parenteral alimentation. A urinary catheter and a central venous pressure catheter were used only in severe cases or if clinical evaluation so indicated.
Following initial stabilization, the patients were taken to the dressing room for re-evaluation and if necessary, debridement, escharatomy, and fasciotomy, and wounds were cleansed and closed using one of the local chemotherapeutic agents, such as silver sulphadiazine, mafenide acetate, or silver incorporated amniotic membrane. This procedure was repeated until all nonviable tissue was removed in cases where amputation was required. Wounds were then closed whit a skin graft or a flap.
Besides systemic and surgical treatment, 5 of our 6 multiple severe trauma patients were rehabilitated through physical therapy and prothesis.

These five patients required a total of 15 surgical procedures (each patient at least two procedures) which included 6 major upper and 4 major lower extremity amputations. The rest were minor, such as debridements and grafts.
After completely recovering from acute bum treatment all five patients had a different number of protheses: one patient required all 4 extremities protheses (blue collar worker); one right forearm (secretary); one left forearm (teacher); one left below knee and right above knee (farmer); and one bilateral total upper extremities prothesis (designer).
At present, all of our five patients are doing very well with their occupations and living without creating any problem with minimal help in society.

Electrical bum injury is one of the severest problems in our population. The main causes of injury in the over 15 years old group was misuse, inattentiveness, and lack of knowledge, also the fact that utility poles and wiring are constructed low and extremely close to buildings, where even putting up a TV antenna can be life threatening. In the under 15 years old group, the injuries were mainly a result of mischievous activity that involved climbing, and lack of parental supervision. Another contributing factor is the lack of control of the systems by the electric companies.
One of the major complications was musculosketetal, which resulted in most of the major amputations.
We found that one of the reasons for the high number of amputations could be that early surgical decompression with fasciotomy and sequential wound debridement (1, 2, 4, 5) was in many cases not accomplished as early as possible because the patients were transported to our centre from nonspecialized facilities. Following electrical and other types of bum injuries physical and occupational therapy must be applied as early as possible to prevent complications during or after treatment. In our Bum Centre, these methods have been applied for many years as a daily routine, including severely burn patients also. After complete recovery the prothesis is adjusted if necessary. While the prothesis is being prepared, patients have to adapt very well and try to turn back to their near normal or normal life.
Our experience with five patients showed that the patient with severely electrical injury and multiple amputation could tolerate this kind of life very well. Therefore, physical and occupational therapy must be applied as early as possible after electrical injury to return the patient to his normal life in society.

RÉSUMÉ. De janvier 1979 à janvier 1987, 125 patients ont été traités dans notre centre à la suite de blessures dues au courant électrique. De ces 125 malades, 85 avaient plus de 15 ans (89,4% hommes et 10,6% femmes) et 40 avaient moins de 15 ans (92,5% hommes et 7,5% femmes). Les individus de plus de 15 ans étaient principalement des électriciens tandis que dans le groupe de ceux de moins de 15 ans il y avaient surtout des étudiants.
En plus du traitement systémique et chirurgical, 5 de nos 6 patients ayant subi de multiples traumatismes ont recouvré leurs fonctions grâce à une thérapie physique et des prothèses et ont pu reprendre leur place dans la société.