High-voltage electrical burn with median nerve salvage using Axoguard Nerve Protector and anterolateral thigh free...

High-voltage electrical burns present as complex peripheral nerves damage, with complete recovery of nerve function rarely seen, especially in mixed motor and sensory innervation injury. Current treatments such as autografts carry the risk of donor site morbidity and potential neuropathy. In this case, a 35-year-old line worker sustained an electrical burn while at work and examination revealed a large volar burn along the right arm, hand, left hand, chest, and leg. After debridement, exposure of the radial artery, median nerve, and flexor tendons in the right upper extremity was noted. Further operative examination confirmed compartment syndrome of the volar compartment. The median nerve was identified as extensively damaged but physically intact. A multimodality approach was taken to avoid donor site morbidity, with a right upper extremity fasciocutaneous anterolateral thigh free tissue transfer and an Axoguard Nerve Protector (40 × 7 mm). Functional recovery was demonstrated at 8-month follow up.