SUMMARY. A brief description is given of a case involving a man suffering from deep injuries due to the passage of electric current in both arms. Through this description we wish to demonstrate our strategy for the selection of the most appropriate surgical techniques, illustrating this with relevant photos. The formation of thrombi in the brachial arteries obliged us to proceed to bilateral amputation at the level of the forearms. Even though this patient now has no hands, he made a full recovery and leads a normal life.
The passage of electric current causes deep injuries to the anatomical structures, leading to serious consequences for the patients.1 The commonest sites for such accidents due to electricity are power stations, which are often unsupervised and thus allow people free access, thus making it possible for them to come into contact with high-voltage cables.2,3 Such contact is therefore generally the result of professional incompetence, technical negligence, or - not infrequently - excessive curiosity.
Usually, after such patients have been given first aid by ambulance personnel, they are sent on to more specialized facilities, like the patient in this report, who was transferred from a regional hospital to our Service of Burns and Plastic Surgery at the Mother Teresa University Hospital Centre in Tirana.
In most cases, after emergency escharotomy and early eschar excision, patients have to undergo limb amputations, giving rise to serious rehabilitation problems that are not only medical but also social.4-6 In our everyday practice patients with electrical burn injury who have suffered amputation of two limbs are not rare, and there are even records of four-limb amputations.
Our clinical case demonstrates deep thermal damage caused by the passage of electric current through the upper limbs of an adult patient. We describe the utmost efforts of the medical staff to preserve as much as possible, but the formation of thrombi in both brachial arteries precipitated the situation and prompted bilateral amputation of both upper limbs, at the level between the medial and distal thirds of the forearms.7,8 In spite of this misfortune, the patient’s great optimism and zest for life enabled him to achieve complete rehabilitation, resulting in full reintegration without any burden for his family or society.
On 30 April 2004 the patient Eligert N., 17 years old, resident in the town of Korça, suffered injuries to both upper limbs caused by accidental contact with high-voltage electric current. Under medical care, he was transferred to our service on the day of the accident and continued treatment in our intensive care unit. The following diagnosis was made on admittance: “electrical burns in both radiocarpal and cubital areas” (Fig. 1).
<% immagine "Fig. 1","gr0000042.jpg","Deep injuries due to passage of electric current in radiocarpal area (same view on both sides).",230 %>On the second day of treatment he was taken to the operating theatre and debridement of the wounds in the radiocarpal areas was carried out, as well as escharotomy in both cubital areas (Fig. 2).
<% immagine "Fig. 2","gr0000043.jpg","Eschar excision in radiocarpal area on day 2 of treatment.",230 %>On day 3 there was clear evidence of full necrotic tissues also on all the fingers, which until then had been ischaemic. The patient was taken back to the operating theatre and a second operation was performed, with an incision in the medial side of the brachial region in the right upper limb. We found a thrombus in the brachial artery, which was the cause of the devitalized hand (Fig. 3).
<% immagine "Fig. 3","gr0000044.jpg","Clear evidence of thrombi in brachial artery.",230 %>The same observation was made in the other extremity. The medical staff decided to perform amputation of both hands, preserving as much vital tissue as possible. We closed the wounds by secondary intention, at the level between the middle and the proximal thirds of the forearm.
The patient was rehabilitated very soon. His psychological and emotional condition improved with time. Now he can move and use perfectly well what remains of his arms, avoiding use of a modern prosthesis. He can dress himself, eat, and write on his own and he lives an almost normal life (Fig. 4). The postulate in describing this case is: Nothing is impossible.
<% immagine "Fig. 4","gr0000045.jpg","Satisfactory rehabilitation of patient two years after injury.",230 %>It is an obligation of the medical staff to care for the prevention and avoidance of thermal injury caused by electric current. Schools and work sites are the places where this propaganda work should be carried out.
After the initial emergency treatment the medical staff must quickly decide on the most appropriate surgical technique. Waiting too long is not in favour of the patient, because inactivity creates the conditions for the onset of local or generalized complications.
A patient’s psychological and emotional state has to be prepared to accept the approach chosen for each concrete case, and this moment is very important for successful recovery in the future. Patients should return to everyday life as normal people.
RESUME. Les Auteurs décrivent brièvement le cas d’un patient atteint de lésions profondes dues au passage d’un courant électrique dans tous les deux bras et démontrent à travers cette description, illustrée avec les photographies relatives, leur stratégie pour choisir les techniques chirurgicales les plus appropriées. La formation de thrombus dans les artères brachiales les a obligés à procéder à l’amputation bilatérale au niveau des avant-bras. Même sans les deux mains le patient décrit dans ce cas s’est rétabli parfaitement et conduit une vie normale.