Management of electrical burns of the upper extremity

The true extent of an electrical burn is even less apparent than the extent of heat burn. Surface diagrams are often useless for calculating the extent of underlying injury. A benign-appearing small electrical burn of the arm may cover an extensive area of deep necrosis. Topical chemotherapy, so successful in thermal injury, is ineffective by itself in electrical trauma—where large volumes of deep tissue may be injured. Early debridement of the necrotic tissue, followed by early coverage with biological dressings and later skin autografting, may save the extremity and even life. Watchful waiting invites complications, such as gas gangrene. Because the eventual tissue loss may be far greater than was first anticipated, a conservative initial debridement followed by daily wound inspection and then secondary debridement as necessary, is the best way to proceed. Successful early skin grafting is sought, to obtain early and satisfactory coverage.