High-voltage electrical injury: a role for mandatory exploration of deep muscle compartments

Patients sustaining high-voltage electrical burns involving the upper extremities were evaluated for deep muscle compartment necrosis by early surgical exploration. Following resuscitation, patients were taken to the operating room where mandatory exploration of volar and extensor forearm and hand compartments was done to evaluate muscle viability. It was observed that deep muscle layers sustained the greatest thermal injury and that extended fasciotomies were required to obviate compartment syndrome and the potential for continued ischemia. Although 10 emergency amputations were required for six patients, those who underwent extensive exploration of their forearms and hands did not require subsequent amputation for nonviable extremities during second-look operations. These observations support the role for early exploration with generous exposure of deep muscle compartments to access and treat the thermal injury that results from high-voltage burns.