HIGH-VOLTAGE INJURY - SPECIAL ASPECTS AND TREATMENT

High-voltage injuries cause localised entrance and exit burns, extensi ve are, flame and flash burns and, even more dangerous, necrosis of th e underlying muscles on the pathway of the current through the body. T herefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be ju dged by the percentage and depth of the skin burn. Diagnostic fascioto mies, radical debridement, and in many cases early amputation are nece ssary to prevent life-threatening complications. Over a period of 10 y ears, 43 patients with high-voltage injuries have been treated at the Hamburg Burn Center, 36 of them in primary care. Common causes of inju ry were accidents in railway areas (28%), using portable aluminium lad ders near overhead power lines (9.3%), and working on electrical equip ment (30.2%). Six of the primary care patients died (16.6%), and 34.9% had an amputation of one or more extremities. Nearly all patients und erwent several debridement and split-skin graft procedures. In 30% of cases additional free and pedicled flaps were needed to cover soft tis sue defects. Ten patients (23.3%) sustained fractures and other injuri es from falls, seven (16.3%) of them severe polytrauma. Initial cardia c arrhythmics were diagnosed in 16.6% of the primarily treated patient s. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these cau sed solely by the electric current.