The Surgical Management of Electrical Burns

Abstract

Electrical burns represent one of the most complex forms of thermal trauma because the visible cutaneous injury frequently underestimates the extent of deep tissue damage. High-voltage injuries are particularly associated with progressive muscle necrosis, vascular thrombosis, compartment syndrome, infection, limb loss, and long-term functional disability. Surgical management requires early recognition of deep injury, aggressive resuscitation, timely decompression, serial debridement, and staged reconstruction. Although early fasciotomy and escharotomy may reduce the risk of compartment syndrome and amputation, definitive reconstruction must be carefully timed because electrical injury evolves over days to weeks. Skin grafting remains the most commonly used reconstructive option for superficial or adequately prepared wounds, whereas local, pedicled, and free flaps are required for exposed bone, tendon, nerves, vessels, or joints. Microsurgical reconstruction has expanded limb-salvage possibilities, but flap failure remains a concern when reconstruction is attempted before tissue demarcation and vascular stability are achieved. Despite advances in critical care, wound therapy, and reconstructive surgery, standardized protocols remain limited, and most available evidence comes from retrospective studies, institutional series, and observational reviews. This review summarizes current surgical principles in electrical burns, emphasizing timing of decompression, debridement, reconstruction, complications, and future research priorities.