SUMMARY. Over a period of 3 years, 21 patients aged 2-75 years with various types of electrical burns were admitted and treated as -emergenties in the Department of Plastic and Reconstructive Surgery at St. Andrew's General Hospital in Patras, Greece. Ten patients developed complications in the cardiovascular, renal and central nervous systems. The various steps of treatment, in collaboration with other specialities in our hospital, and the reconstructive procedures are presented.

Introduction
A burn is defined as electrical when it is caused by electric current (E.C.) (direct or alternating). The damage that a tissue suffers depends on its resistance. Resistance is a measure of how difficult it is for electrons to pass through a material. The unit of measurement is the ohm.
Voltage, resistance and amperage interact according to Ohm's law: amperage
voltage/ resistance. The extent of injury correlates with Joule's equivalent: heat = 0.24 x amperage2 x resistance x time.
The resistance of normal dry skin is 5,000 ohms/cm2. The resistance of wet skin is 1,000 ohms/cm2. The resistance of a calloused palm may reach 1,000,000 ohMS/CM2. The most resistant tissues ,are,the skin and the bones.
Direct E.C. of low voltage causes superficial burns, while alternating E.C. can cause tetanic muscle spasms, fixation of the victim to- the current source, fractures, and cardiac and respiratory arrest.

Material and methods
All 21 patients were treated in the period 1989-1991. Their ages ranged from 2 to 75 years.

Discussion
1. Skin.- this may be affected in a variety of ways, from minor superficial bums to extensive damage and necrosis. Exposure of the skin to 50 V for 6-7 sec results in blisters.
2. Veins and muscles: thrombosis occurs at some distance from the original injury. It may be progressive or not. Small muscular arterial branches susceptible to thrombosis lead to necrosis of the muscle fibres. The largest densities of E.C. possibly pass through the muscles. Myoglobin is liberated from the destroyed fibres, and myoglobinuria therefore indicates muscle destruction.
3. Kidneys: acute renal failure may occur. The causes are myoglobinuria, haemoglobinuria, decreased glomerular filtration rate and hypovolaemia. Amputation of an extremity or resection of a portion of the torso may be necessary if myoglobinuria persists.
4. Cardiopulmonary system: 10-20% of patients suffer this kind of injury. They may develop coronary artery spasm, coronary endarteritis, diffuse myocardial muscle damage, atrial fibrillation, myocardial infarction (anterior chest wall burns), pleural effusion and pneumonitis (thoracic wall burns), and respiratory arrest from muscle contraction.
5. Nervous system: injury to the C.N.S. may present as unconsciousness, hemiplegia, aphasia, epilepsy or headache. When the lesion is at the level of the spinal cord the patient has herniplegia or quadriplegia. Lesions of the peripheral nerves may also occur.
6. Gastrointestinal tract: the E.C. can cause direct injury to the abdominal wall. Curling's ulcers in the stomach or duodenum are caused by stress and are indirect injuries. Bowel perforation is a complication that occurs early or late. Sometimes dysfunction of the gallbladder, liver or pancreas is present. If this induces a diabetic state we administer insulin.
7. Bones: these are usually injured in high tension accidents. Necrosis of the periosteum and destruction of the calcium phosphate matrix, especially in the skull, are common. Fractures may happen owing to muscle contraction or falls after loss of consciousness.

Two patients died out of the 2 1, the death rate thus being 9.5%. One death, due to cardiopulmonary complications, was caused by a high-voltage accident. The other fatality followed an, industrial accident and death was caused by sepsis.
On the basis of our experience we propose the resuscitation measures to be taken as soon as possible. Cardiopulmonary resuscitation may be necessary at the place of accident. Administration of fluids and stabilization of renal function are also essential.
Early surgical intervention and surgical desloughing, followed by reconstruction with the use of skin grafts and flaps, are recommended when possible. The collaboration of many specialists -plastic surgeons, urologists, cardiologists, general surgeons, neurosurgeons and anesthesiologists - is necessary.
Attention must be focused at the points of entrance and exit. Escharotormes, fasciotomies and surgical removal of destroyed skin and muscles must be performed. Decompression of the compartments is necessary. For the prevention of stress ulcers we administer ranitidine (Zantac) and antiacids. Tetanus toxoid booster doses must be administered to every patient. For full-thickness bums we propose reconstruction with the use of grafts and flaps.

RESUME Pendant une période de 3 ans, 21 patients Agés de 2 A 75 ans atteints de divers types de brOlures électriques ont été hospitalisés et traités dans le service de chirurgie plastique et réparatrice du centre hospitalier St. Andrew's de Patras, en Gr~ce. Dix patients ont présenté des complications des syst&mes cardiovasculaire, rénal et nerveux central. Les auteurs décrivent les phases successives du traitement, avec la collaboration des autres spécialités présentes dans leur centre, ainsi que les procédures de reconstruction.

BIBLIOGRAPHY

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