Electrical Burns

 

HEPARIN THERAPY IN ELECTRICAL BURNS:

First Study and Pictures

Saliba MJ, Reyes A, and Lockard JS

Studies found that adding Heparin prior to surgery in non-electrical burns improved both treatment and results.

Therefore Heparin was selected as a test factor in this study.

Heparin was added prior to surgery in 36 patients injured by 31 high voltage and 5 low voltage electric currents.

16 of the 36 patients were additionally burned by the electricity-ignited fires.

14 patients were initially rendered unconscious.

Doses were regulated by clinical response and Blood Clotting Times within the normal range or 1 to 3  times normal clotting time.

 

Method

Heparin was started Day 1, < 4 hours post-burn in 30 patients, and Days 2-12 in 6.

Heparin was:

  • Sprayed topically on burn surfaces in diminishing amounts until healed,
  • Infused intravenously for 3 post-burn Days only,
  • Variably injected subcutaneously 2-30 days

And inhaled in 2 patients

Doses were regulated by clinical response and Blood Clotting Times within the normal range or 1 to 3 times normal clotting time.

With Heparin Added:

• Pain was relieved;

• Swelling and resuscitation fluids were reduced;

• Blood loss and transfusions were avoided;

• Ischemic tissues were revascularized;

• Fasciotomies were a total of 7 ;

• Highly vascular granulation tissue facilitated the 12  smaller size skin graftings;

• Amputations were 4;

• The resulting skin was usually smooth without scars and contractures;

Operations Prior to Heparin Use

• 3 patients who sustained initial trauma had 3 laceration repairs Day 1. Two of the 3 lost blood that required transfusions Day 2;

• 2 patients who sustained lung burns had airway tubes inserted Day 1 and tracheostomies Day 2;

• 1 amputation

Clinical Results

Heparin’s anticoagulating, anti-inflammatory, neoangiogenic, tissue-restoring, and epithelializing therapeutic effects were evident; and concise therapy for the matching burn pathology.

•  No blood clotting thrombi, infarctions, or embolizations were noted.

•  Pain was relieved, swelling and fasciotomies were reduced.

•  Ischemic tissues were revascularized. Highly vascular    granulations enhanced healing and reduced graftings. 

•  The new skin was smooth skin except small areas in 4 Pts.

• Days in Hospital were 18.6 av/pt.

 

Total Surgical Procedures

30 individual operations were performed in the 36 Pts  Using heparin

14 Pts required no surgery.

• 1 Pt had debridement  of his infected foot necrosis.

• 2 Pts had a tracheostomy Day 2.

• 3 Pts had a laceration repair Day 1.

• 7 Fasciotomies were performed in a total 6 Pts.

• 12 Pts had skin graftings.  

• 5 Pts had an amputation.

 

Statistical Evaluation

The 36 electric current and fire burned patients in this study with heparin added to the treatment, were compared to 3,903 similar patients similarly injured and similarly treated without heparin added.

 

Statistical Summary

Heparin significantly reduced Days in Hospital (p<.02), operations (p<.005); and amputation rate (p<.0001).

 

Statistical Evaluation Details

 The significant differences in heparin treated patients compared to 3,903 cohort patients not treated with heparin in up to 28 prior studies were:

• In TBSA size, 21%  av. versus 11.1% av. size in 21 prior studies (t = 6.9, p<.001);

•in % of high voltage patients, 86% of 36 pts vs. 70% in 28 studies (t=2.47, p<.05);

•Days in Hospital were 18.6 with heparin vs. 31.7 av. without in 14 studies (t= 2.77, p<.02);

 

Statistics continued

•operations were 0.83 av./pt with heparin versus 3.58 operations without in 10 studies (t=4.51, p<.005);

•and amputation rate of 5 total in this 36 pt study was 13.88% versus 37.39% av without heparin in 28 studies (t=7.72, p<.0001).

 

Summary

The surgery-dominant traditional treatment of electricity injured and fire burned patients was cost-effectively significantly improved when heparin was administered topically and parenterally before surgery. 

Surgical removal of burn lesions was not necessary because heparin patients were not toxic, none died; and much burn healing occurred. 

Surgical loss of blood requiring transfusions was eliminated.

The addition of heparin significantly reduced, but did not eliminate the need or election to do surgical procedures when operations were required or procedures would improve, facilitate, or shorten healing. 

Necessary surgery was performed at a slightly delayed and more advantageous time in reduced frequency and lesser amount under improved conditions.

 

Conclusion:

Adding heparin prior to surgery cost-effectively improved electrical current and fire burn treatment and results.

Adding heparin provided medical doctors a renewed role in burn treatment, and appropriately reserved operations for surgeons.  Costs were much reduced.

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