Response to Letter to the Editor: Comments on “Analysis of factors influencing limb amputation in high-voltage electrically injured patients”

We appreciate the comments of Dr. Badoiu and Dr. Caramitru about our study [Hsueh Y-Y, Chen C-L, Pan S-C. Analysis of factors influencing limb amputation in high-voltage electrically injured patients. Burns 2011;37(June (4)):673‐7]. We agree with their experience in that clinical symptoms are of utmost importance in detection of the muscular lesions and determination of amputation. It has been a widely accepted principle that early surgical intervention should be done in patients with obvious compartment or muscle necrosis. However, atypical compartment syndrome usually occurs in a very different clinical setting and is difficult to discern in the early stage. Aggressive surgical debridement (escharotomy, fasciotomy, fasciectomy) every day during the first 3‐4 days after electrocution may help release compartment pressure and prevent further muscle damage caused by ischemia. But the inhomogeneous injury pattern of muscle necrosis caused by electroporation may hamper adequate debridement. That is why selective decompression should be performed at 3‐5 days after injury [1]. The contribution of CK-MB in the early stage of electric injury is an interesting finding in our study. The dramatic decrease of CK-MB level following decompression may indicate the injured limb is salvageable. We also agree with the point that we should be alert in electrically injured patients with high CK-MB levels, whereas an appropriate cutoff level to alert us to pay attention to the muscle condition remains a concern. CK-MB, having statistical evidence and result, will no doubt assist in assessing the possibility of limb amputation. Its importance can not be overlooked in early stage of electric injury. However, a large prospective study should be performed to determine the real value. Further, the pathophysiology of muscle damage between