Edward J. Bartle

Free Skin Flap Transfer in Repairing Deep Electrical Burns

From November 1977 to July 1984, we successfully treated 12 of 14 cases with severe electric burns by free skin flap transfer. A free frontal-exterior femoral flap (one case), free groin flaps (two cases), free scapular flaps (three cases), and free dorsalis pedis flaps (eight cases) were transferre

Inhibition of Colony-Stimulating Factor (CSF) Production by Postburn Serum: Negative Feedback Inhibition Mediated by Lactoferrin

Fatal infections in severely burned patients are often preceded by a decline in the production of colony-stimulating factor (CSF) and the proliferation of granulocyte-macrophage stem cells (CFU-GM), and overwhelming sepsis is often associated with leukopenia. The underlying mechanisms accounting for these granulopoietic defects are poorly understood, but the fact that postburn serum has been shown to inhibit CSF production suggests that a humoral factor or factors may play a role. Previous work has demonstrated that plasma levels of lactoferrin (LF), a known inhibitor of CSF production, are elevated following burn injury. To determine if LF is responsible for serum-mediated inhibition of CSF production, serial plasma levels of LF were measured in 18 burn patients using an enzyme-linked immunoabsorbent assay (ELISA). LF was elevated within 24 hours of injury and was associated with an absolute granulocytosis which rapidly declined, reaching a nadir at postburn days 3 through 5. Postburn serum, especially when collected during the first 24 hours following burn injury, inhibited in vitro CSF production by normal human peripheral blood mononuclear cells. Pre-incubation of postburn serum with an LF antibody restored normal CSF production. These data suggest that LF may play an important role in the regulation of postburn granulopoiesis.

Creatinine phosphokinase values in electrical and thermal burns.

Twenty-six patients were evaluated with regard to CPK values in week 1 post-burn. Patients were allocated into two groups based on the severity of burn injury. Group 1 included patients with minor electrical or thermal injury, and Group 2 those patients with deep thermal injury and objective evidence of muscle necrosis. With the exception of day 5 post-burn, Group 2 had significantly increased CPK levels as compared to Group 1. This indicates that CPK levels, especially with electrical and deep thermal burns, are sensitive tests in evaluating the depth of burn injury such that an appropriate pre-operative strategy for debriding and grafting is possible.

Early vascular grafting to prevent upper extremity necrosis after electrical burns: Anastomotic false aneurysm, a severe complication☆

From May 1972 to January 1982, early vascular grafting was used to re-establish circulation across the electrically burned wrist. Thirty-three thrombosed arterial segments (radial and/or ulnar arteries) were removed in 18 limbs and autografts of the greater saphenous or omental veins were used for the revascularization. One vascular graft, which had been sutured to the ulnar artery on day 3 post-injury, contained an anastomotic false aneurysm at the proximal anastomosis. One month after vascular grafting, this aneurysm ruptured and bled. An emergency exploration of the wrist confirmed the diagnosis and surgery successfully restored the circulation, avoiding amputation of the injured limb. Histopathological examination of the specimen was consistent with the presence of anastomotic false aneurysm. The pathogenesis of this complication is reviewed. Our experience indicates that circulation to a limb following electrical injury can be successfully restored by early vascular grafting, but emphasizes the importance of close periodical follow-up after graft acceptance due to the possibility of late anastomotic complications.

Early vascular grafting to prevent upper extremity necrosis after electric burns: additional commentary on indications for surgery.

Early vascular grafting has been used to reestablish circulation to the hand in the treatment of electric injuries of the wrist with arterial damage. Since 1972 this therapy has yielded good results by preventing necrosis of the injured hand and by helping to maintain function. However, the indications and timing for performing this operation still are poorly defined. The surgeon is faced with the difficult task of determining whether the injury is severe enough to affect distal circulation and thereby lead to necrosis. The lack of reliable clinical signs is chiefly responsible for this difficulty; however, the potential for delayed thrombosis of vessels complicates the problem. In this article, indications for early vascular grafting in an electrically injured wrist are discussed based on recent clinical experience, with emphasis on the use of arteriography. A case history involving electric burns of both upper extremities is presented as an illustration.

Transplantation of anastomosed vascular allomentum and split thickness autogenous skin grafting for repair of deep electrical burns of the wrist

The use of allomentum to replace automentum or skin flaps in treating 3 patients with severe electrical burns of the wrist is discussed, as are the specific advantages and disadvantages, and the prospects for clinical use of the technique.

Regeneration of full layer necrosis of the skull following high voltage electrical injury

Scalp and skull necrosis often follow high voltage electrical injury to the head. Classically reconstruction of the scalp and skull is performed after sequestration of the necrotic bone. The relatively frequent complication of epidural infection, however, detracts from this approach. As an alternative we have attempted to induce regeneration of devitalized bone by covering it with a vascular tissue flap. A typical patient is described in this report with results which indicate that at least partial regeneration of the necrotic tissue can occur, thus one-stage management of such wounds is possible.