A Case-Matched Controlled Study on High-Voltage Electrical Injuries vs Thermal Burns

Abstract

The aim of this study was to provide an increased level of evidence on surgical management of high-tension electrical injuries compared with thermal burns using a case-controlled study design. Sixty-eight patients (64 males, 4 females, aged 33.7 +/- 13 years) with high-tension electrical burns were matched for age, gender, and burnt extent with a cohort of patients sustaining thermal burns. Data were analyzed for cause of accident (occupational vs nonoccupational), concomitant injuries, extent of burn and burn depth, surgical management, complications, and hospital stay. High-tension electrical burn patients required an average of 5.2 +/- 4 operations (range, 1-23 operations) compared with 3.3 +/- 1.9 (range, 1-10 operations) after thermal burns (P = .0019). Amputation rates (19.7% vs 1.5%), escharotomy/fasciotomy rates (47% vs 21%), and total hospitalization days (44 d vs 32 d) were significantly higher in high-tension electrical injuries (P < .05). Creatinine kinase levels were significantly elevated during the first 2 days in patients with subsequent amputations. Free flap failure was observed during the first 4 weeks after the trauma, whereas no flap failure occurred at later stages. Local, pedicled, and distant flaps were used in 15% of the patients. The mortality in both groups was 13.2% vs 11%, respectively (nonsignificant). High-voltage electrical injury remains a complex surgical challenge. When performing free flap coverage, caution must be taken for a vulnerable phase lasting up to 4 weeks after the trauma. This phase is likely the result of a progressive intima lesion, potentially hazardous to microvascular reconstruction. The use of pedicle flaps may resemble an alternative to free flaps during this period.

Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study

“…Handschin et al[19] reported average 44 d of hospital stay and Noble et al[1] in their study reported hospital stay 24.5 ± 21 d in electrical injuries.…”

Alterations in arterial function after high-voltage electrical injury

“…Many cases of HVEI to the upper arms inevitably lead to amputation because the massively destroyed vessel walls easily undergo coagulation necrosis, leading to thrombosis and local obstruction of blood flow. The distal ends of the injured limbs may then become gangrenous [5,14]. …”

“…Usually, HVEI is associated with entry and exit wounds, and assessment of the pathway allows prediction of the organs at most risk of damage [2]. In HVEI, nearly 90% of victims have injuries in their upper extremities [3,4], with amputation required in 24% to 49% of cases [5,6]. The extent of the injury depends on the electrical voltage, the local tissue resistance, the pathway of the current flow, and the duration of the contact [7].…”

Single‐stage Matriderm® and skin grafting as an alternative reconstruction in high‐voltage injuries

“…Fascial flaps (3), preexpanded flaps (4,5), composite tissue flaps, multiple flap transplantations in the same patient and combined flaps (‘chimeric’ flaps) based on a single pedicle have been performed in patients with severe burns and high‐voltage injuries (6). However, the risk of flap failure in high‐voltage injuries ranges between 10% and 30% because of microvascular damage by the electrical current (7–9). Therefore alternative techniques for reconstruction have to be kept in mind.…”