Electrical Injuries

The Iceberg Phenomena

  • Krishna Manandhar Tribhuwan University Teaching Hospital
  • Jayan Man Shrestha Tribhuwan University Teaching Hospital
  • Sangam Rayamajhi
  • Ishwar Lohani Tribhuwan University Teaching Hospital

Abstract

Introduction: The deceptive nature of electrical injury is likened to an iceberg phenomena. Whether the tissue is conductive or resistant both are injured due to electroporation and heat, respectively. The objective of the study is to evaluate the types and pattern of injuries and attempt to predict the chances of various types of injuries and highlight the iceberg phenomena.
Methods: A retrospective study includes 36 patients. Injuries were classified into superficial and deep. Total burned surface area (TBSA) was categorized into four, </= 5%, 6 to 10%, 11 to 20%, and > 20%. The depth of injury was categorized into superficial and deep. Deep injuries were elaborated into loss of skin, muscle, tendon, nerve, artery, cartilage and damage of bone and internal organs. Treatment was grouped into conservative and surgical, where surgical was classified into minor, major and amputation procedures.
Results: Injuries were mostly located over the upper extremities (47.76%). The first TBSA category had the highest number of patients (64%), highest percent of superficial and deep injuries (63.88% and 61.29%, respectively) and highest percentage of procedures (64.25%). The average number of procedures per patient was 3.8. The median burned surface area (BSA) was 4% and most of the procedures were performed in patients with less than 4% BSA.
Conclusion: Electrical injuries are truly iceberg phenomenon where a small area of TBSA hides the greatest percentage of the deep structure injuries and brings about surprising reconstructive challenges.
 
Key: electrical injury; nerve, arterial, tendon injuries; skin loss; amputations; debridements; skin grafting; reconstructive flaps.

Author Biographies

Krishna Manandhar, Tribhuwan University Teaching Hospital
I  am 3rd year Plastic Surgery resident in the Department of Plastic Surgery and Burns in Tribhuwan University Teaching Hospital. 
Jayan Man Shrestha, Tribhuwan University Teaching Hospital
Dr Jayan Man Shrestha is a Consultant Plastic Surgeon in the Department of Plastic Surgery and Burns in Tribhuwan University Teaching Hospital. He holds Masters in Surgery and FCPS in Plastic Surgery. He is also a Fellow in Hand Surgery from National University Hospital, Singapore.
Sangam Rayamajhi
Dr. Sangam Rayamajhi is a faculty and Junior Consultant in the Department of Plastic Surgery and Burns in Tribhuwan Universtiy Teaching Hospital. He holds M.S. and MCh in plastic surgery from Tribhuwan Universtiy Teaching Hospital.   
Ishwar Lohani, Tribhuwan University Teaching Hospital
Dr. Ishwar Lohani is the Head and Professor of the Department of Plastic Surgery and Burns in Tribhuwan University Teaching Hospital. He holds M.S. and MCh from India.
Published
2018-07-11
How to Cite
MANANDHAR, Krishna et al. Electrical Injuries. Journal of Society of Surgeons of Nepal (JSSN), [S.l.], v. 20, n. 2, p. 4-12, july 2018. ISSN 2392-4772. Available at: <http://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=300>. Date accessed: 17 oct. 2018.
Section
Original Article