Revascularize or Amputate? Underrated Arterial Damage in High-Voltage Electrocution: A Literature-Informed Clinical...

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Electrophysiology

Background:

• High-voltage electrocution causes extensive multisystem damage, including critical vascular injuries.
• Decisions between revascularization and amputation for limb salvage are complex due to risks like hemorrhage and infection.

Purpose of the Study:

• To review current literature on managing vascular injuries from high-voltage electrocution.
• To present a case utilizing an arterial interposition graft for limb salvage in electrocution injury.

Main Methods:

• A comprehensive literature review was conducted using PubMed, Scopus, and Cochrane databases.
• Keywords included "electrocution" and "arterial injury"; 19 human studies were selected.
• A case report details an arterial interposition graft using the deep inferior epigastric artery (DIEA) for an upper limb injury.

Main Results:

• Most reported reconstructive options involve venous grafts or flow-through flaps.
• This study reports the first use of an arterial graft (DIEA) in this context.
• Despite successful graft placement, early thrombosis and distal ischemia led to limb loss in the presented case.

Conclusions:

• Vascular injury from electrocution is often more severe than initially apparent.
• Reconstructive surgery for limb salvage should be reserved for stable patients, prioritizing dominant limbs in younger individuals.
• Arterial grafts may not overcome the extensive damage from electrocution; further research is needed for management guidelines.