Search

The passage of electric current through a human body causes polarization changes in cell membranes, which can possibly lead to the death of these cells. At the same time, electric energy is transformed to thermal energy, primarily in high resistance tissues. We present a case report of a 22-year-old male who was hit by an electric current with a voltage of 22 kV when he was working on a high-voltage overhead line tower. Primary treatment which included fasciotomies was completed two hours after the injury. Fasciotomies and revisions of all muscle groups were completed on the left upper extremity and right shank. On the right upper extremity fasciotomies were completed on the forearm. Retinaculum flexorum was cut in the area of both wrists. Despite the complex therapy including higher doses of a low-molecular-weight heparin, ischemization of the whole left upper extremity and distal part of right shank and foot occurred. On the sixth day after the injury it was necessary to amputate the right lower extremity in shank and on the eighth day after injury to amputate the left upper extremity below the shoulder, and on the fourteenth day, due to progressive ischemic necrosis, it was necessary to complete exarticulation of the left shoulder. The 45th day after the injury our team of micro-surgeons closed the defect of soft tissues in the distal part of right forearm and radial part of right hand by transferred parascapular fasciocutaneous flap. The right median nerve appeared to be necrotic in the distal part of forearm even at the day of injury. Four months after the injury the 12 cm long defect of the right median nerve was bypassed by a graft from the suralis nerve. Outpatient care followed as well as physical and psychological rehabilitation. The support of the family was admirable. One and a half years after the injury reconstruction of the right thumb flexor tendon was completed. Two years after the injury function of the right hand in terms of grip function was satisfactory (patient was able to complete pinch grip and sign). Gait with the prosthesis was very good.

Injuries caused by high-tension electrical current are rare, but pathophysiologically unique with destructive effects. As a form of thermal trauma, electrical injuries represent a connection of skin burns and deep tissue destruction unpredictable in its depth which mostly resembles a crush injury. Emergency treatment measures begin with the separation from the electrical contact if any and prompt transport to the nearest institution with all means for cardiorespiratory resuscitation and complete recovery. Resuscitation of the patient after electric shock continues then with fluid replacement using special formula modified for such cases, correction of acidosis and myoglobinuria and finally with escharotomy and fasciotomy which is most often necessary.

In the submitted case-report the authors describe a combination of a reconstruction operation with an orthopaedic approach to a devastating injury of the shoulder and elbow in a 26-year-old patient after an electric current injury. The total extent of the skin damage was 13% T.B.S.A. with localization on the right side of the chest, right arm, left elbow and shoulder. After fascial excisions the proximal part of the humerus was amputated with fixation by means of cerclage to the scapula. This defect was covered with the musculus latissimus dorsi flap and the defect on the elbow was covered by a tube pedicle flap.

40 patients suffering from electrical injuries were rehabilitated using a new system of urgent conservative debridement and flap coverage in the period from October 1984 to July 1988. For this purpose, a 1-4 year follow-up was needed. Good appearance and functions of the extremities or organs were obtained and the amputation rate was lower (7.5%) than that used in patients treated with traditionally conservative methods (47.7% in the same hospital.