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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 21  |  Issue : 1  |  Page : 67-70

Involvement of head and neck in high voltage injuries: A study from Himalayan valley


1 Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
2 Department of Social and Preventive Medicine, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
3 Department of Cardio Vascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India

Date of Web Publication22-Nov-2013

Correspondence Address:
Adil Hafeez Wani
Department of Plastic Surgery, SKIMS, Soura, Srinagar, Kashmir, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.121887

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  Abstract 

Background: With increasing use of electricity in our day-to-day life the incidence of electrical injuries is increasing. Incidence is higher in developing countries where people are less acquainted to proper and safe use of electricity in contrast to developed countries. Objectives: (1) To study the clinical profile of high voltage injuries to the head and neck region (2) To know the reason for the higher incidence of such injuries and find out various preventive measures to reduce such injuries in future (3) To launch an awareness program among the electrical department workers about electrical injuries and their prevention. Materials and Methods: All patients with high voltage electrical injuries to the head and neck region reporting to our center were included in the study. The study was conducted retrospectively from January 2001 to May 2008 and prospectively from June 2008 to December 2010. A total of 54 patients were included in the study. Results: Involvement of head and neck region was seen in 25.35% of high voltage electrical injury victims. The most common age group was 20-30 years with a mean age of 29.13 ± 8.37 years. Incidence was higher in rural population 75.93% compared with urban 24.07%. Incidence was higher in winter months. Electricians comprised 59.26% of victims. The most common mode of injury was touching the live wire directly or indirectly and was seen in 74.07% patients. Average total body surface burn was 16.32 ± 8.13%. An average of 2.91 surgical procedures per patient were performed. Reconstructive procedures were required in 85.18% of patients. Average hospital stay was 26.81 days. Conclusions: High voltage injuries are not uncommon in Kashmir valley and electric department workers are at a greater risk. The incidence of high voltage injuries would not have been so high had the electric workers been properly trained, hazards of high tension lines explained and use of safety equipments made mandatory.

Keywords: Electrical, head and neck, high voltage


How to cite this article:
Kasana RA, Wani AH, Darzi MA, Tabassum A, Ganie FA. Involvement of head and neck in high voltage injuries: A study from Himalayan valley. Indian J Burns 2013;21:67-70

How to cite this URL:
Kasana RA, Wani AH, Darzi MA, Tabassum A, Ganie FA. Involvement of head and neck in high voltage injuries: A study from Himalayan valley. Indian J Burns [serial online] 2013 [cited 2021 Jun 18];21:67-70. Available from: https://www.ijburns.com/text.asp?2013/21/1/67/121887


  Introduction Top


In the modern times the use of electricity has increased many times and so has the incidence of high voltage electrical injuries. The incidence of high voltage electrical injuries is much higher in developing countries when compared to developed countries, lack of proper transmission system being the cause. [1] About 0.8-1.0% of accidental deaths are due to electrical injury and constitute 3-9% of all patients treated in burn centers. Electrical injuries cause around 1000 deaths in U.S. each year with a mortality rate of 3-15%. [1],[2]

Electricity is the flow of electrons across a potential gradient. [3] Electric current is divided into high or low voltage depending upon whether it is above or below 1000 volts. [4] "Let go" is maximum current at which a person can release the conductor before muscle tetany makes it impossible. For an adult "let go" current is 6-9 mA. Blood vessels, muscles and nerves are better conductors of electricity than bone, fat and skin. [5]

Injuries caused by electricity can be of three types; (a) direct contact burn, (b) flash burn or (c) burn from an electric arc. Effects of electricity on the body are determined by type, amount and pathway of current, duration and area of contact, resistance and voltage. [6]


  Materials and Methods Top


The study was conducted in two parts; (a) retrospective from January 2001 to May 2008 and (b) prospective from June 2008 to December 2010. All patients reporting to accident and emergency department with history of high voltage injury with involvement of head and neck region were included in the study.

In retrospective group, the case records were collected from the medical record department. The case sheets these 38 patients were analyzed for all relevant information regarding epidemiological and clinical variables such as the type of current, mode, location, extent and severity of injury, associated injuries and treatment received. In prospective group Advanced Trauma Life Support protocol was followed for stabilization of patients on arrival to the emergency room. Fluid replacement was titrated to maintain urine output of 0.5-1.0 ml/kg/h. Patients were catheterized and urine analysis for myoglobinuria was performed. A complete history regarding occupation, cause of electrical injury, site of accident, duration of contact, tension of electric current (voltage) etc., was recorded.


  Results Top


Out of 213 patients of high voltage injuries 54 patients had involvement of head and neck region. Males were more commonly affected 51 males against 3 females. Incidence of injuries was higher in rural areas as compared to urban, 75.93%. The patients in this study had the age range from 10 years to 48 years. The mean age was 29.13 ΁ 8.37 years. The most common age group was 20-30 years constituting 53.70% of victims.

The incidence was higher during winters i.e. from December to February 38.89% and another peak in summer months i.e. from June to August 29.63% [Table 1]. Among the patients studied the most common occupation group was electric department workers constituting about 59.26% followed by farmers 10.79%. Work related injuries were seen in 75.93% of patients and this group of patients included 26 electricians, 5 farmers, 5 labourers, 4 construction workers and one transporter.

Direct contact with a live wire was the most common mode of injury and was seen in 36 (66.67%) patients. Falling of live wire was next common mode of injury in 11 (20.37%) patients. Four patients had indirect contact through some conducting object, two hit by lightning and one received injury following a transformer burst [Table 2]. None of the victims were using helmets, safety belts except a few using insulated pliers [Table 3]. 34 (62.96%) patients had contact burns, 16 (29.63%) had a combination of contact and flash burns and 4 (7.41%) patients had pure flash burns. The scalp was the most common area of involvement seen in 38 patients followed by face in 24, neck in 12 and forehead in 8 [Figure 1] and [Figure 2]. Total body surface area burnt was 16.32 ΁ 8.13%. 84.90% patients had entry site located in the head and neck region. Exit site was seen in lower limbs in 66.67% patients and 22.23% in upper limbs and trunk. A total of 26 patients had a history of fall from height and associated injuries which included fractures in 18 patients, intracranial injuries in 4 patients, blunt abdominal and thoracic injuries in 6.
Figure 1: Electric burn over the nose and reconstructive surgical procedure

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Figure 2: Combination of contact and flash burn

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46 (85.18%) patients required different surgical procedures for head and neck burns which included; multiple debridements in 40 patients, skin grafting in 34 patients, flaps in 26 patients, vacuum assisted closures in 8 patients and tissue expanders in 2 patients [Figure 3]. Average surgical procedure per patient was 2.39. Average hospital stay was 26.81 days.
Figure 3: Exposed scalp bone and rotational flap cover

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Complications were recorded in 11 (21.57%) patients. Early complications included convulsions, acute renal failure and septicemia. Late complications included empyema lung, cataract and paraplegia [Figure 4]. One patient died of acute renal failure following extensive burns.
Figure 4: Cataract in a patient with facial contact burn

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  Discussion Top


High voltage injuries were seen more commonly in males. [7],[8] The reason could be males being involved more in outdoor activities and electricians are mostly males. The younger age group (20-30 years) [9],[10] was more vulnerable to high tension injuries because of their careless attitude and high risk taking behavior.

Head and neck region involvement comprised of 25.35%of total high voltage injuries and is quite high than other parts of the world. [11],[12] The reason is mainly lack of use of helmets and thus the head touching live wires. Lack of proper transmission lines like laying over of lines on trees, low lying high tension lines and breaking and falling of weak lines also contributes to head and neck injuries.

Higher incidence in rural areas was due to lack of proper transmission lines and lack of staff, forcing locals in maintenance [13] (Local unskilled population resort to repairing line themselves due to lack of adequate staff). Lines are laid over trees in rural areas exposing farmers and children to risk. Increased number of accidents in winter months is due to more of faulty lines following heavy snowfall requiring frequent repairs. These increased number of accidents in winter months are not due to conductance of current through snow, but due to increased weight of snow causing line and poles to fall on the ground causing accidents and later lines being charged while workers are still repairing them due to lack of communication.

In summers construction activities are at their peak in Kashmir thus more power demand and accidents.

Electrical department workers, especially daily wagers, were the most commonly affected group and the reason was a lack of proper training and non-adherence to safety norms. We observed that none among the victims was using safety belts, electricians gloves, helmets etc. Different reconstructive procedures were required in 81.48% of patients to cover raw areas or exposed bones and to reduce the disabilities. Cataract was noticed in one patient after 4 months of injury. [14]

Thus we concluded that high voltage injuries involving the head and neck region are common in Himalayan valley and most of these injuries are work related. The age group more commonly affected includes inexperienced and inadequately trained young daily wagers of the electrical department. The incidence of such injuries would not have been that high had the use of helmets and other safety measures been made mandatory. Proper training of electric department worker can prevent such accidents in future. Up-gradation of transmission lines especially in rural areas is equally important to reduce the incidence of such injuries. The other measures include proper communication between the workers repairing lines and grid station, high quality transmission lines and poles, periodic maintenance and strict implementation of safety norms. For the general population mass media awareness programs on electrical safety and hazards are necessary. To increase awareness we have used FM radio, workshops and distributed handouts on preventive measures.

 
  References Top

1.Haberal MA. An eleven-year survey of electrical burn injuries. J Burn Care Rehabil 1995;16:43-8.  Back to cited text no. 1
[PUBMED]    
2.Lee RC. Injury by electrical forces: Pathophysiology, manifestations, and therapy. Curr Probl Surg 1997;34:677-764.  Back to cited text no. 2
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3.Dalziel CF. Effects of electric shock on man. IRE Trans Med Electron 1956;5:44-62.  Back to cited text no. 3
    
4.Achauer B, Applebaum R, Vander Kam VM. Electrical burn injury to the upper extremity. Br J Plast Surg 1994;47:331-40.  Back to cited text no. 4
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5.Price T, Cooper MA. Electrical and lighting injuries. Rosen's Emergency Medicine. 5 th ed., Vol. 3. Missouri, USA: Mosby; 2002. p. 2010-20.  Back to cited text no. 5
    
6.Rai J, Jeschke MG, Barrow RE, Herndon DN. Electrical injuries: A 30-year review. J Trauma 1999;46:933-6.  Back to cited text no. 6
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7.Haberal M. Electrical burns: A five-year experience - 1985 Evans lecture. J Trauma 1986;26:103-9.  Back to cited text no. 7
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8.Marshall KA, Fisher JC. Salvage and reconstruction of electrical hand injuries. Am J Surg 1977;134:385-7.  Back to cited text no. 8
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9.García-Sánchez V, Gomez Morell P. Electric burns: High- and low-tension injuries. Burns 1999;25:357-60.  Back to cited text no. 9
    
10.Mohammadi AA, Amini M, Mehrabani D, Kiani Z, Seddigh A. A survey on 30 months electrical burns in Shiraz University of Medical Sciences Burn Hospital. Burns 2008;34:111-3.  Back to cited text no. 10
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11.Wilkinson C, Wood M. High voltage electric injury. Am J Surg 1978;136:693-6.  Back to cited text no. 11
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12.Hussmann J, Kucan JO, Russell RC, Bradley T, Zamboni WA. Electrical injuries - Morbidity, outcome and treatment rationale. Burns 1995;21:530-5.  Back to cited text no. 12
[PUBMED]    
13.Haberal M, Uçar N, Bilgin N. Epidemiological survey of burns treated in Ankara, Turkey and desirable burn-prevention strategies. Burns 1995;21:601-6.  Back to cited text no. 13
    
14.Saffle JR, Crandall A, Warden GD. Cataracts: A long-term complication of electrical injury. J Trauma 1985;25:17-21.  Back to cited text no. 14
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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