Mr S.H. was a 28 year old self employed welder who was referred to the National Orthopaedic Hospital, Enugu (NOHE), from another tertiary centre after a high voltage electricity injury sustained one week earlier.
The patient had accidentally touched an overhead high voltage wire (supposedly transmitting 11 000 V) with a long pole whilst working on top of a one storey building situated under a high voltage line. He was wearing gloves but was not wet at the time of the incident. Following contact he was transfixed to the pole for about 20 minutes before being rescued by a neighbour using a wooden stick. He lost consciousness but did not fall from the building. He was taken immediately to a nearby teaching hospital where he regained consciousness after about an hour. Severe burn injuries to all his limbs were identified. Following initial treatment, he was referred to our centre at his request after he declined an offer of amputation. We found gangrene of the left forearm extending up to the cubital fossa, and gangrene of the right upper limb from the hand to the proximal third of the forearm with exposure of the radius and ulnar. The right lower limb had 14% septic deep dermal burns with extensive eschar. The left lower limb had 4% mixed thickness burns with eschar on the dorsum of the foot.
The patient was co-managed by the plastic and orthopedic surgery units. He was properly counselled and had provisional bilateral amputations of the upper limbs the same day (left above elbow and right below elbow) as well as wound debridement and escharectomy of the lower limb wounds. His rehabilitation is ongoing at the time of this report (Figure 1).
Masters A.C. and D.E. are cousins who sustained severe high voltage electrical injury whilst trying to adjust their television antennae to obtain a clearer view during a world soccer tournament. The TV antenna accidentally touched a high voltage electric wire passing directly over their roof (11 000 V transmission line). They were transfixed for a length of time until they were extricated using a wooden stick and then transferred to a nearby general hospital where they were initially treated before referral to our centre by the fourth day.
On presentation, both had gangrenous upper limbs up to the mid forearms. D.E. had, in addition, flame burns of the anterior abdominal wall, left medial distal arm and the axilla totalling 10% of the total body surface area (TBSA). Patient A.C. had, in addition, flame burns of the left arm, posterior aspect of the right arm and temporal aspect of the scalp, totalling 8% TBSA; he also lost his left ear. All the burnt surface areas were infected. Their 24 hours urine output was greater than 1.8 L per person. They were counselled for amputation to which they consented, and bilateral below elbow provisional amputations were performed and later re-fashioned (Figure 2 and Figure 3).
Upon discharge from the hospital there was no follow-up.