PubMed · 158652
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C V Hays. 1979. Making laparoscopy electrically safer. An engineer's approach.. https://pubmed.ncbi.nlm.nih.gov/158652/
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Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. The fundamental difference between high voltage electrical injury and lightning is the duration of exposure to current. Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.
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Although there have been great advances in the treatment of electrical injuries in the last 20 years, the extremity loss ratio in electrical injuries remains at an unacceptably high level. The primary cause is due to the progressive tissue necrosis which results in the continuous extension of necrosis in the wound, leading to loss of the whole injured extremity. This study reports attempts to break the dangerous tissue necrosis circle and save the form and function of damaged extremities. After 14 years of systematic experimental and clinical studies a successful comprehensive urgent reconstruction alternative (CURA) for electrical injuries is proposed. CURA includes: debriding the wound as early as possible after injury; preserving the vital tissue structures as much as possible, such as nerves, vessels, joints, tendons, bone, even though they have undergone devitalization or local necrosis; repairing these vital tissues during the first surgery if functional reconstruction requires it; protecting the wound bed by covering with tissue flaps of rich blood supply; improving flap survival through moist dressings supported by continuous irrigation beneath the flaps for a 24-72h period after surgery with measures to control local infection; and last, giving general systemic treatment with vasoactive agents and antibiotics. Four hundred and fifty nine wounds in 155 patients suffering from electrical injuries have been successfully treated with this technique between 1986 and 2000 and are reported in this paper. Satisfactory results were obtained with the extremity loss proportion reduced to less than 9% compared with 41.5% during the 10 years before 1984 in the same hospital. The authors suggest that CURA is an effective and workable method for treatment of electrical injuries.