Experiences in the treatment of electrical burns covering deep wounds with various tissue flaps

From 1979 to 1986, 121 patients with electrical burns were admitted to our, unit (6% of all the burned patients admitted during that period). Of these cases 64 were regarded as having deep burns (e.g. burns which injured muscles, tendons, nerves, bones and capsules of the joints etc.). Thirty-five flaps of various types of tissues (including one free muscle flap, two island fascial flaps, four island skin flaps, three arterial skin flaps, two musculocutaneous flaps and twenty-three random skin flaps) were used for the coverage of deep burns in twenty-seven patients. Thirty three flaps survived completely while two were partially lost; three flaps developed severe sub-flap infections but the tissue of the flaps survived totally. Three typical cases are reported in this paper. The advantages of early extensive exploration and thorough debridement of the deep electrical wounds are discussed. It also introduces the practical usage of various flaps for wound coverage in these typical cases. When flaps were needed for deep electrical burns, we chose local flaps first, and used axial pattern flaps, island flaps, etc. as much as possible; if only a random flap was available in the site, we elevated it with some deep fascia to enhance its ability to prevent infection. We considered the free tissue transfer and the transfer of fascial flaps to be important alternatives. Debridement followed by immediate wound coverage should be done as soon after resuscitation as possible. Generally the operations were performed within the third to fifth days after the electrical burn. This is the best period for active treatment in order to salvage the remaining functions of the burned extremities. Operations performed after six days must be done only under the careful control of anti-infective measures. From our experience we have found that muscle flaps and musculocutaneous flaps were the most suitable approaches for the coverage of deeply infected wounds especially when bones were involved. Careful attention was taken to excise the necrotic muscle tissues, especially those that were "sandwiched" between necrotic muscle bundles. This was done primarily by gross evaluation according to the judgement of the surgeon intraoperatively. The swollen and hardened regions of the skin of involved extremities generally corresponded to the areas of necrotic muscle tissue at about three days after the injuries or later. This was used as a reference to indicate where to place or extend the exploratory incisions. We frequently preserved denatured peripheral nerves and tendons, because these injured structures often later regain their functions partially or completely with a reliable coverage.(ABSTRACT TRUNCATED AT 400 WORDS)