High-voltage electrical injuries are relatively rare injuries that pose unique challenges to the treating physician, yet the initial management follows well-established life-saving, trauma- and burn-related principles. The upper extremities are involved in most electrical injuries because they are typically the contact points to the voltage source. The amount of current that passes through a specific tissue is inversely proportional to the tissue's intrinsic resistance with electricity predominantly affecting the skeletal muscle secondary to its large volume in the upper extremity. Therefore, cutaneous burns often underestimate the true extent of the injury because most current is through the deep tissues. Emergent surgical exploration is reserved for patients with compartment syndrome; otherwise, initial débridement can be delayed for 24 to 48 hours to allow tissue demarcation. Early rehabilitation, wound coverage, and delayed deformity reconstruction are important concepts in treating electrical injuries.
From the Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN.
Dr. Lee or an immediate family member has received royalties from Zimmer Biomet; is a member of a speakers' bureau or has made paid presentations on behalf of Zimmer Biomet; serves as a paid consultant to Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, the American Shoulder and Elbow Surgeons, the American Society for Surgery of the Hand, and the Association of Bone and Joint Surgeons. Dr. Desai or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of AxoGen; serves as a paid consultant to Acumed; and serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand. Neither Dr. Gauger nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.