|
KMID : 0853020080110020113
|
|
Journal of Korean Burn Society
2008 Volume.11 No. 2 p.113 ~ p.126
|
|
|
The Role of Early Selective Fasciotomy and PGE1 to Reduce the Major Amputation Rate in Electric Burns
|
|
Kim Jae-Hwan
Kim Hyun-Chul
|
|
|
Abstract
|
|
|
Purpose: A vast array of injuries result from high voltage electrical damage. The arc burns have high risk of amputations. There are controversies about the effect of fasciotomy. The un-approximated long fasciotomy skin incision is prone to super-infection and leads to amputations. We investigated the major amputations to suggest the way to reduce the rate.
Methods: We reviewed 1,029 high voltage damage victims during the last 12 years. Changed strategy: Stage 1 (1996∼ 1999): The conventional fasciotomy was performed when the limb had the evidence of compression symptoms (clinically 5Ps). After the debridement of devitalized tissues, the skin graft was done to cover the fasciotomy wound. The major amputation rate was 16.6% (69/416). Stage 2 (2000∼2002): We performed selective fasciotomy when digits still remained as a stenosis on PCR of Plethysmography. We tried early skin graft or shoe-lace sutures. However the rate was 18.6% (52/280). The exploration of amputee showed the leading cause of amputation was vascular spasm and thrombosis. Stage 3 (2003∼2007): Duplex scan monitoring was done to evaluate the vascular wall and blood flow changes of wrist. We administered the lipoPGE1 (Eglandin?) 10μg/day for 7 days (mean) starting before fasciotomy and covered the open wound with various fasciocutaneous flap. The rate reduced to 9.9% (33/333).
Results: The analysis of 2,296 burned limbs of 1,029 victims (G-1; no PGE1; 1,849, 80.5% vs G-2; PGE1 administration; 447, 19.5%) showed that the early fasciotomy (within 8 hr) could reduce major amputation rate (64.4% to 57.1%), specifically in Arc burns (64.5% to 54.1%). The early fasciotomy with PGE1 administration could reduce amputation rate more effectively (48.4% to 32.7%), specifically in Arc burns (66.7 to 22.7%) than direct contact burns (35.7 to 44.4%).
Conclusion: The early, selective fasciotomy and PGE1 administration are essential to reduce major amputations in Arc burns. Various types of reconstructive flap surgery are mandatory to save the limb.
|
|
|
KEYWORD
|
|
|
Major amputation rate, Early selective fasciotomy, PGE1 (Eglandin), Electric burns
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|