M. E. Asuquo, MBBS, FWACS, FICS, I. A. Ikpeme, MBBS, FWACS, FICS, and I. Abang, MBBCH
A 22-year-old woman with a history of inability to use both upper limbs since 2 months presented in the accident and emergency unit. This followed a lightning strike in a village while she was asleep in the house. She was partially clothed with the trunk exposed during the incident. There was no history of loss of consciousness. Following the injury, she sought treatment from a traditional/spiritual healer in view of the superstitious belief of being attacked by evil forces.
On examination, she was in poor general condition, febrile, and anemic. She had healing/ or infected superficial burns that involved the right side of the face and neck, the right axilla, breasts, right hypochondrium, and iliac fossa. The lower extremities of the upper limbs had extensive gangrene that extended to the elbows and infected burns on the right arm extending to the deltoid region as well as the anterior part of the left arm (Figure 1). On examination, chest and abdomen as well as the lower limbs were normal.
A diagnosis of 18% lightning-induced burns with bilateral below-elbow gangrene was made. She was resuscitated with intravenous fluids, antibiotics, and immunized against tetanus. The patient refused amputation after counseling and left the hospital.
Our patient presented with full-thickness infected burns and bilateral gangrene extending to the elbows. The burn injuries became infected overtime and worsened during the period of topical herbal treatment, in view of the history of malodorous discharge with progressive inability to use the limbs. Full-thickness burns rarely result from lightning accidents. However, occasionally there may be an electric burn from direct current flow with clinical manifestation similar to those from a commercial high-voltage electrical injury. A thermal burn results when lightning ignites clothings.
In societies where lightning is not regarded as natural, the traditional healer is usually the first to be consulted. This patient was managed in such facility for 2 months prior to presentation. Therapy for burn injuries includes debridement followed by application of topical antimicrobial agents; we use topical honey. Tetanus prophylaxis is mandatory. When full-thickness burns are evident, excision and autogenous split-thickness skin graft are offered treatment options. Infection from poor wound care may result in the injury worsening and when limbs are involved, gangrene may ensue necessitating limb ablation or death from septicemia, as depicted in this patient. In the absence of gangrene, extensive burn scars may develop, after many years, into squamous cell carcinoma—Marjolin’s ulcer—in poorly managed cases
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Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
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