Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury

Electric Injury

United States Department of Defense

Although the pathologic change resulting from electric injury is coagulation necrosis, the extent and severity of such injury may initially be seriously underestimated. Limited areas of cutaneous necrosis may be evident at points of entry, exit, or arcing, yet be associated with extensive, subcutaneous, deep tissue involvement, leading to an inappropriate estimation of resuscitation fluid requirements. This "iceberg" effect also may necessitate the performance of fasciotomy rather than escharotomy to insure viability of distal unburned parts. The prophylactic use of an osmotic diuretic may be indicated because of extensive muscle necrosis with consequent liberation of hemochromogens. The presence of brawny, deep induration in a limb involved in electric injury, with signs of vascular impairment, indicates a need for fasciotomy. Approximately one-third of all patients with significant electric injury of the extremities will require amputation. This procedure should be delayed until resuscitation has been completed unless signs of systemic toxicity develop. Amputations in this situation as in any thermal injury should be consistent with conservative principles of limb salvage and should be carried out by disarticulation without opening a narrow cavity in the presence of the contaminated burn wound. Because of the difficulty of accurately distinguishing viable and nonviable tissue at the time of initial debridement, patients with high-voltage electric injury should be returned to the operating room 24 hours or, at the most, 48 hours following initial debridement. At the time of reoperation, further debridement is carried out as is necessary or, if no further necrotic tissue is identified, the wound may be loosely closed over tissue drains.

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Operational Medicine 2001

Health Care in Military Settings

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