Abstract
Introduction: The deceptive nature of electrical injury is likened to an iceberg phenomenon. Whether the tissue is conductive or resistant both are injured due to electroporation and heat, respectively. The objective of the study is to evaluate the types and pattern of injuries and attempt to predict the chances of various types of injuries and highlight the iceberg phenomenon.
 Methods: A retrospective study includes 36 patients. Injuries were classified into superficial and deep. Total burned surface area (TBSA) was categorized into four, </= 5%, 6 to 10%, 11 to 20%, and > 20%. The depth of injury was categorized into superficial and deep. Deep injuries were elaborated into loss of skin, muscle, tendon, nerve, artery, cartilage and damage of bone and internal organs. Treatment was grouped into conservative and surgical, where surgical was classified into minor, major and amputation procedures.
 Results: Injuries were mostly located over the upper extremities (47.76%). The first TBSA category had the highest number of patients (64%), highest percent of superficial and deep injuries (63.88% and 61.29%, respectively) and highest percentage of procedures (64.25%). The average number of procedures per patient was 3.8. The median burned surface area (BSA) was 4% and most of the procedures were performed in patients with less than 4% BSA.
 Conclusion: Electrical injuries are truly iceberg phenomenon where a small area of TBSA hides the greatest percentage of the deep structure injuries and brings about surprising reconstructive challenges.
Highlights
The deceptive nature of electrical injury is likened to an iceberg phenomenon
The injuries were classified somewhat similar as for flame injury according to the depth and total burned surface area.Total burned surface area (TBSA) was categorized into four, first is 20%
More than 64% of the procedures were performed in the patients within the first TBSA category
Summary
The deceptive nature of electrical injury is likened to an iceberg phenomenon. Whether the tissue is conductive or resistant both are injured due to electroporation and heat, respectively. Electrical injuries is one of the most deceptive of injuries where the phenotype of the injury may seem very inconspicuous and fool even the experts but the detailed internal effects may surprise even the most attentive, like an iceberg might fool the captain of the ship who can see only the tip. They are the fourth leading cause of workrelated traumatic death in US (5–6% of all workers’ deaths).[1] Electrocutions at home account for more than two hundred deaths per year.[2]. Higher intensity may cause tetany of skeletal muscles, paralysis of respiratory muscles and respiratory arrest, ventricular fibrillation and asystole.[3,4,5]
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