857 Reconstruction of the Pediatric Upper Extremity Following High Voltage Electrical Burn Injury

Abstract

Abstract Introduction High voltage electrical burns are often associated with significant morbidity, posing great acute and delayed reconstructive challenges for plastic surgeons. As survival from these injuries increases, attention has been focused on improving quality of life post burn injury through restoration of sensory and motor function. However, due to the complexity of the upper extremity and its small surface area in pediatric patients, its reconstruction can be a very complex endeavor. Especially in pediatric patients that are still growing, ensuing great risk for upper extremity contracture and deformity. Methods A retrospective chart review was conducted on patients aged 0–18 years admitted to our institution with a high voltage electrical burn involving the upper extremity. The timeframe under study was 13 years from January 1st 2005 to December 1st 2018. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board. Results Out of the 68 electrical burns treated at our pediatric burn center, 58 involved the upper extremity. This further divides into 37 patients with high voltage and 31 patients with low voltage upper extremity electric burns. Of the 37 high voltage upper extremity patients, 35 underwent acute surgical management and 18 had delayed surgical reconstruction for the upper extremity. Conclusions The reconstructive techniques employed at our institution following severe electrical injuries typically follow a reconstructive ladder. The majority of chronic contractures in our series were successfully treated with either minimally invasive techniques such as laser and steroid infiltration, local tissue flaps, or release and skin grafting. Applicability of Research to Practice Multidisciplinary treatment of severe electrical injuries to the upper extremity is vital to optimizing a patient’s long-term function. Given the significant depth of injury in cases of electrical burns to the upper extremity the risk of developing contractures is relatively high. The expeditious treatment of secondary contractures is important to maximize a patient’s long-term function. The general treatment of contractures of the upper extremity should be based on the location and severity of the contracture, with considerations made for the patient’s reconstructive goals.