Is immediate decompression of high voltage electrical injuries to the upper extremity always necessary?
OBJECTIVE
To determine if immediate decompression is required for all high voltage injuries to the upper extremity.


METHODS
Retrospective review.


METHODS
Charts reviewed of 62 patients who had upper extremity contact with >1,000 volts of electricity over a 10-year period.


RESULTS
One hundred upper extremities were treated. Twenty-two percent were decompressed within 24 hours because of progressive nerve dysfunction, clinical compartment syndrome, or failure of resuscitation. This group required a mean of 4.2 operations with an amputation rate of 45%, similar to other series. Thirty-five percent of burned extremities had their first operative procedure delayed until resuscitation was complete. This group required a mean of 2.1 operations with no amputations. Forty-three percent of extremities did not require operations to achieve healing. Overall results show a 10.0% amputation rate and mean hospital stay of 27 days.


CONCLUSIONS
We conclude that the need for amputation and multiple operations is determined by the injury itself and that immediate decompression is only required for the usual clinical signs of compartment syndrome. Selective decompression may actually preserve tissue and decrease the need for eventual amputation because fasciotomy can lead to soft tissue dessication by exposing viable tissue.
Mann
R
R
Department of Surgery, University of Washington Harborview Medical Center, Seattle 98104, USA.
Gibran
N
N
Engrav
L
L
Heimbach
D
D
D000293:Adolescent; D000328:Adult; D001134:Arm Injuries / Q000209:etiology / Q000601:surgery*; D002058:Burns, Electric / Q000150:complications / Q000601:surgery*; D002648:Child; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome