High-tension electrical burns: special problems and their management

Abstract

High tension burn injuries comprise 1% of admissions to burns units and have a high incidence of mortality or amputation of an extremity in patients who survive. A dichotomy regarding treatment rationale for high tension electrically injured patients exists and is supported by two separate views of the pathophysiology of the injury. One view contends that the full extent of the injury occurs at the time of injury and this concept is used to support a philosophy of early radical debridement and reconstruction. Another view is that an element of chronicity exists in wound development and that serial examinations and debridements may be required prior to definitive reconstruction. The treatment rationale presented by the authors is that the high complication rate associated with these injuries, including partial or complete flap failure, as well as the need to preserve vital tissue justifies a cautious reconstructive approach similar to that used in high velocity lower limb injuries with serial examinations and debridements taking place prior to definitive reconstruction. A historical overview and discussion of some of the unique features of high tension electrical injuries is presented and used to support the authors’ philosophy of management.