Electrical burns of the abdomen
A 35-year-old male farmer came in contact with 11,000 volts high tension electric wire while irrigating his field. This patient was initially admitted to general surgery ward from main casualty for management as he was having open abdominal wound and was managed there for initial 3 days. He had full thickness burn wounds over the right scapula, right upper limb and anterior abdominal wall along with perforation of the intestine. There was prolapse of the intestinal loops through abdominal wound. Patient was referred to our plastic surgery unit after 3 days. He presented to us in septic shock with an abdominal drain in place. Details of the preliminary management were unavailable except mention of putting in catheter drain through the open abdominal wounds. There was necrosis of burned skin and muscles over the right shoulder and abdomen []. Patient was initially managed conservatively with intravenous fluids, parenteral nutrition, barrier dressing of the abdominal wound and culture specific antibiotics. Patient responded well to the conservative management and once he was stable, a thorough debridement of the necrotic skin over the right shoulder and upper arm was performed. The area was then split skin grafted. The patient developed enterocutaneous fistula, which healed over a period of 8 weeks. The wound over the abdomen was also covered with skin graft and patient was discharged after 18 days [].\nAbout 4 months after the discharge, the patient presented with ventral hernia and requested reconstruction of the abdominal wall. Repair of ventral hernia by synthetic mesh application and reconstruction of the abdominal wall with flap cover was planned. Per-operatively the abdominal skin graft was separated from the peritoneum and the underlying omentum and an inlay composite mesh was applied to secure the abdominal wall []. The graft was not de epithelialised. It was carefully separated from the peritoneum over the bowels. No perforation occurred. A free tensor fascia lata flap was applied over the mesh, but the flap failed. Then after debridement two random pattern transposition skin flaps, one from the right upper and another from the left lower abdomen were transposed over the abdominal wound and donor area was skin grafted []. Patient was discharged after 17 days with advice to wear an abdominal binder. He is presently in follow-up, it has been 18 months since surgery and there is no ventral hernia and abdominal wall is flat and intact. Patient is satisfied with the results [Figures and ].