|Year : 2020 | Volume
| Issue : 1 | Page : 94-97
Electrical injury in pediatric patients – A case series
K Mathangi Ramakrishnan1, Bala Ramachandran2, KG Ravikumar2, K Ravikumar2, Sulochana Putli3, V Jayaraman1, T Mathivanan1, R Ravi1, S Gnanamani1, Mary Babu1
1 Department of Plastic and Reconstructive Surgery, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
2 Department of Pediatric Intensive Care, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
3 Department of Microbiology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
|Date of Submission||14-Oct-2019|
|Date of Decision||22-May-2020|
|Date of Acceptance||24-Oct-2020|
|Date of Web Publication||21-May-2021|
Prof. K Mathangi Ramakrishnan
Kanchi Kamakoti Childs Trust Hospital, Chennai
Source of Support: None, Conflict of Interest: None
Electrical injuries in children are gruesome injuries that result in disabilities and death in developing countries. In this article we present a series of 6 children who were treated for electrical burns. Reconstructive surgery followed by prolonged rehabilitation is required.
Keywords: Electrical burns, high tension electrical injury, electrocution in children
|How to cite this article:|
Ramakrishnan K M, Ramachandran B, Ravikumar K G, Ravikumar K, Putli S, Jayaraman V, Mathivanan T, Ravi R, Gnanamani S, Babu M. Electrical injury in pediatric patients – A case series. Indian J Burns 2020;28:94-7
|How to cite this URL:|
Ramakrishnan K M, Ramachandran B, Ravikumar K G, Ravikumar K, Putli S, Jayaraman V, Mathivanan T, Ravi R, Gnanamani S, Babu M. Electrical injury in pediatric patients – A case series. Indian J Burns [serial online] 2020 [cited 2021 Jun 18];28:94-7. Available from: https://www.ijburns.com/text.asp?2020/28/1/94/316575
| Introduction|| |
Acute electrical injury is type of thermal injury that occurs due to passage of electric current through the body. It can be low-voltage (<1000 volts) injury or high-voltage (more than 1000 volts) voltage. It is a sad fact that children between 0 and 18 years are the victims of this in developing countries due to exposure of electrical cables and lack of awareness.
Electrical injury often involves the skin, subcutaneous tissues, and bone and can lead to amputation and devastating consequences. Other medical consequences such as electrocardiogram abnormalities, cardiac dysfunction, acute myolysis, and myoglobinuria may require these children to be managed in specialized pediatric intensive care units (PICU).
In the article, we describe our experience of managing five children with high- and low-voltage electrical injury.
| Materials and Methods|| |
All children between 0 and 18 years admitted to the PICU of a tertiary care pediatric hospital with a history of electrical injury are included in the study. Informed consent has been obtained from the patients' family. Children are managed according to the PICU protocol by trained pediatric intensivists with attention to airway, breathing, restoring circulation, treating infections, renal support, and cardiac support as required. Surgical management is undertaken as soon as their general condition permits.
| Description of the Cases Studied|| |
Case 1: Newborn baby
A newborn baby delivered by cesarean section for the indication of hand prolapse suffered an electrical injury when the arm was immersed in a warm water tub still connected to the electrical inlet. The left forearm suffered a severe electrical injury resulting in compartment syndrome and absent radial pulse. After initial treatment to establish hemodynamic stability, escharotomies were done to relieve the compartment syndrome, after which the radial pulse returned.
The baby gradually recovered with some gangrene of the tip of the fingers and the remaining portion had normal vascularity with restricted function [Figure 1].
|Figure 1: Newborn baby with electrical injury to left forearm. clockwise from top left: compartment syndrome, wound healing with edema, fingers amputated due to gangrene, healing after skin graft|
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Case 2: 3 year old
A 3-year-old child was sitting on a sofa in the drawing room, while playing with a metal wire, inserted it in an open electrical socket meant to supply a large air-conditioning unit. He suffered electrical injury, mainly involving the right hand and parts of the face.
The injuries were third-degree burn patch on the right thumb tip and right web, right upper and lower eyelids, and upper and lower lips [Figure 2]. The child had to be admitted in the PICU where he was treated for 3 weeks, and reconstructive surgeries were done after edema settled. Skin grafting was done to the right thumb tip and web. The child recovered completely.
|Figure 2: 3 years old with third degree electrical injury to right thumb, web and right half of face. Images show edema followed by gradual healing and final results after skin graft|
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Case 3: 14 years old
A 14-year-old boy was flying a kite on the rooftop of a house in a poor neighborhood which had high-tension wires passing over the terrace. While trying to retrieve his kite which was entangled with the electrical wire, he got electrocuted. He was brought to the emergency room of the hospital located 135 km away. He had fourth-degree charred skin over the entire chest from the lower end of the neck to the groin.
Elaborate escharotomies were done around the chest and abdomen, as seen in the picture. This was required to avoid restriction of chest movements [Figure 3]. After ensuring adequate breathing and ventilation over 4 days, dead tissues were removed surgically. The raw area was covered with collagen sheets (Kollagen™). Once his general condition improved, split skin graft was applied. As his thighs were free, we were able to take large sheets of skin for skin graft and all the wounds healed well. He did not have much of tightness on the front of the abdomen, as his back was free of burn. Pressure garments were applied and he has gone back to school.
|Figure 3: 14 years old child with fourth degree electrical burns to right side of chest and abdomen. Escharotomies done, Kollagen applied and finally wound healed with large sheets of skin graft.|
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Case 4: 10 year old
A 10-year-old child was playing in corn fields and was trying to pluck a few fresh corns to eat. The high tension wires going over the fields had come down very low and seemed to have been buried among the corn plants. Not realizing this, the boy tripped and fell facedown. He developed a burst abdomen due to contact with the wire and all the small intestine came out [Figure 4]. He was brought in a moribund state to us and a laparotomy was performed and a double-barreled ileostomy also was done and kept in the PICU. However, he succumbed within 24 h due to Gram-negative septicemia.
|Figure 4: Deep electrical injury to abdomen resulting in intestines protruding, treated by laparotomy and ileostomy. Severe gram negative sepsis ensued which was fatal|
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Case 5: 18 year old
A 18-year-old fresh recruit to the railway department was placed as trainee assistant lineman. His job involves climbing on top of the train. He became unsteady and got in contact with high-tension wires on top of the train with both hands. He suffered severe injuries to both upper limbs requiring amputation [Figure 5]. He required a prolonged convalescence in the hospital and rehabilitation.
|Figure 5: An 18 years old, new Railway recruit working on top of railway coach suffered electrical injury to both upper limbs resulting in amputation|
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Case 6: 14 year old
A young boy of 14 years of age while cycling home found a disconnected electrical line dangling by the side of the road. He stopped and got down from the cycle to hold the dangling wires. As this was a severed high tension wire hanging, he was electrocuted and fell down. His left hand and wrist were damaged. Several of the fingers and thumb were severely damaged and had to be removed. After the initial failure of split skin graft, a bi-lobed superiorly based abdominal flap was used to reconstruct the little finger [Figure 6]. The damaged area of the radius was reconstructed with bone graft. The patient is awaiting a free thumb reconstruction. Regular physiotherapy and rehabilitation has been provided.
|Figure 6: Severe electrical injury to left hand and wrist sustained by holding a dangling electrical wire. Abdominal flap was used to reconstruct the finger and bone graft used for radius|
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| Conclusions|| |
Electrical injuries in children need timely management to avoid morbidity and mortality. Prolonged rehabilitation is often required to establish a useful function of the affected part. Expert management in the PICU is life-saving in these patients. It is unfortunate that children in developing countries suffer from these injuries which are totally preventable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Faggiano G, De Donno G, Verrienti P, Savoia A. High-tension electrical burns. Ann Burns Fire Disasters 1998:11:162-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]