Early excision for electrical burns of the hand allows the earliest repair, avoids infection, preserves function, and facilitates reconstructive surgery. The results in twenty patients treated by excision within ten days from the time of injury are reviewed.
Small high-voltage punctate injuries and electrical flash injuries usually heal spontaneously and skin-graft repair is not necessary.
Early excision is indicated for low-voltage contact injuries, large high-voltage punctate injuries, and extensive high-voltage injuries. At early excision the experienced surgeon can usually determine the extent of burn necrosis of the deep structures; but if there is doubt, a second look a few days later will reveal whether all necrosed tissue has been removed. If tendons, nerves, bones, and joints are exposed after excision of an electrical burn, rotation or pedicle-flap repair is preferred. If this is not possible, split-skin graft repair is adequate.
Extensive high-voltage injuries with vascular impairment may benefit from excision-decompression of a tight eschar about the burned hand. In these ischemic hands, and when there are flame burns, primary repair is contra-indicated. Staged excision and systematic repair-or amputation of gangrenous or useless parts-may be accomplished early, since extensive necrosis from vascular impairment is diagnosable at the time of the injury, and progressive necrosis from bacterial invasion of marginally viable tissue can be avoided by early excision.
Copyright 1966 by The Journal of Bone and Joint Surgery, Incorporated