Electrical injury management in the Prague Burn Center

From January 1984 to June 1992, there were 500 patients admitted on an annual average; electrical injuries represented 4–5% of these cases. Apart from casualties with devastation of both upper extremities with necessitated amputation above elbow, there were manifold other locations in of extensive electrical injuries requiring an interdisciplinary approach in the ICU and an individual approach regarding local reconstructive procedures. Decompressive surgery was accomplished immediately, simultaneously with resuscitation, necrectomy followed after 3–4 days using xenografts as temporary cover. For permanent coverage of exposed tendons, nerves, bones, or capsulas of the joints, various types of flaps were used. A special problem was encountered in cases with facial defects. The tubed-flap technique which was pioneered by our late Professor Burian in 1912, later to be prompted by Filatov and Gillies, is still useful in some cases. Inner aspect of arm and neck offer the best quality of skin for face reconstruction. This method has several advantages: all stages can be performed under local anesthesia; all stages require basic knowledge and experience in reconstructive surgery using the simplest instruments; any mature tubed flap is suitable for meticulous modelling, which is particularly necessary in the face. Another problem was encountered in an 18-year-old girl who sustained high-voltage electrical injury, with 65 % burn of total body surface area. She was unconscious and on artificial ventilation (tracheostomy) for 13 days. Loss of soft tissue exposing bone in the occipita-parietal region was replaced by means of "bridge" flap with one pedicle covered with graft as well as secondary defect. Patients with large total body surface area burns are severely compromised, and the use of free flaps (prolonged periods of anesthesia and surgery) should be a judicious decision.