Train surfing and other high voltage trauma: Differences in injury-related mechanisms and operative outcomes after fasciotomy, amputation and soft-tissue coverage

• Published in: Burns Vol. 37; no. 8; pp. 1427 - 1434
• Main Authors: Lumenta, David Benjamin, Vierhapper, Martin Friedrich, Kamolz, Lars-Peter, Keck, Maike, Frey, Manfred
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.12.2011; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Amputation; Amputation - statistics & numerical data; Biological and medical sciences; Burns; Burns, Electric - pathology; Burns, Electric - surgery; Critical Care; Electric burns; Electric injuries; Extremities - surgery; Fasciotomy; Female; Flaps; Humans; Length of Stay; Male; Medical sciences; Orthopedic surgery; Outcome Assessment (Health Care); Railroads; Retrospective Studies; Soft Tissue Injuries - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical decompression; Train surfer; Traumas. Diseases due to physical agents; Young Adult; Electric burns; Train surfer; Flaps; Electric injuries; Surgical decompression; Amputation; Skin disease; Prognosis; Trauma; Burn; Treatment; Surgical amputation; Surgery; Soft tissue; Flap (surgery)
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2011.07.016

Abstract Background In the context of scarce reports on train surfers among high voltage electric injuries, we conducted a retrospective review between January 1994 and December 2008. Methods After matching for inclusion criteria we reviewed patient records of 37 true high voltage injuries (12 train surfers [TS] and 25 other high voltage injuries [HV]). Results TS were significantly younger (TS 15.8 years vs. HV 33.3 years, p < 0.0001), and had a greater %TBSA (TS 49.7%TBSA vs. HV 21.5%TBSA, p = 0.0003) without affecting the median length-of-stay (TS 52 days vs. HV 49 days) or number of operations (TS 4 vs. HV 3). TS had different injury patterns, with a higher percentage of affected extremities (TS 72.9% vs. HV 52.0%, p = 0.0468) and associated injuries (TS 58% vs. HV 20%, n.s.) than HV. Both groups demonstrated comparable fasciotomy (TS 71.4% vs. HV 55.8%) and amputation rates (TS 17.1% vs. HV 15.4%). While TS required less flaps (TS 3/12 vs. HV 18/25; p = 0.0153), soft-tissue reconstruction revealed an overall low incidence of complication rates (one partial pedicled flap loss and two total free flap losses). Conclusions Train surfers have proven to be a distinct group of patients among high-voltage injuries notably as a result of a younger age, a shorter electric contact duration and higher velocity-induced trauma. With a possibly declining trend of train surfing-related accidents in an aging society, it will be interesting to see if emerging economies will face comparable phenomena, for which prevention strategies remain key.