|
KMID : 0853020080110020099
|
|
Journal of Korean Burn Society
2008 Volume.11 No. 2 p.99 ~ p.112
|
|
|
Investigation of Arterial Rupture Related to Electrical Burns
|
|
Jang Tae-Young
Kim Hyun-Chul
|
|
|
Abstract
|
|
|
Purpose: The arterial rupture is known as one of the late complications. We investigated the clinical consequences of arterial ruptures.
Methods: We reviewed 35 episodes in 29 victims (2.7% of 1,092 of high tension injuries) during the last 12 years. The study includes the site of spontaneous rupture (G1: subeschar vs G2: zone of ischemia) and iatrogenic rupture (G3), causes (spontaneous or iatrogenic; inflammatory or associated thrombotic), sites, time and consequences of ruptures (site of ligature, vascular manipulation).
Results: The 12 ruptures of G-1 (9 patients) were P.pollicis, D.pollicis, 2 D. Indicis, 3 Radial, 2 Ulnar, Brachial, Axillary and P.Tibial arteries. The 17 ruptures of G-2 (15 patients) were 7 Radial, 6 Ulnar, 2 Brachial and 2 Popliteal arteries. The 6 ruptures of G-3 (5 patients) were 2 SFA, Subclavian, P.Pollicis, P.Tibial and Ulnar arteries. The 5 patients (19.2%) had multiple ruptures in 1∼13 days after the first episode. There was hardly any time difference in occurrence between G-1 and G-2 (30.1±24.7, median; 21.0 vs 18.1±9.2, median; 19.0 PBD). But The G3 occurred earlier than G1 and G2 (6.5±3.0, median; 6.0 PBD). The rupture at ZOI occurred at 2∼7 cm apart from burn eschar margin. The iatrogenic rupture occurred within 2 cm from clamping, ligature or anastomosis sites after vascular procedures by inflammation. Twenty among 29 spontaneous ruptures were caused by inflammation alone at 25.1±20.9 PBD. The rest 9 thrombotic ruptures occurred at 18.7±8.0 PBD, not different from inflammatory ruptures. The most common site of thrombotic rupture was at the margin of thrombi (6 cases). The ligation at 1 cm proximal to rupture site for small sized arteries and 4 cm proximal for medium sized arteries were relatively safe. The thrombi were formed finally in Fem-Pop bypass graft at 9 cm proximal from the original rupture site after the repeated vascular procedures.
Conclusion: Careful attention should be paid to select the safe distance for vascular procedures. In forearm, ligature at 4 cm proximal artery of fresh unburned area is adequate. The vascular procedures should be performed at least 10 cm away from the rupture site in deep arteries. We recommend that timely decision to amputate must be made to reduce spontaneous ruptures.
|
|
|
KEYWORD
|
|
|
Arterial ruptures, Electrical burns
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|