OBJECTIVES
High voltage electrical injuries (HVEI) can be devastating injuries with great soft tissue loss and peripheral nerve injury, which can result in the amputation of the limb, especially in the upper extremity. Since the pathophysiology is highly complex, reconstructing these burns still represents a difficult issue for the burn surgeon.
We describe the case of an HVEI in the hand with associated nerve injury and review the literature on this type of injury and its soft tissue and nerve reconstruction options.
METHODS
A 50-year-old male, who suffered an HVEI in his right hand presented at our center with a third-degree burn on the palmar side that exposed tendons. We evidenced a paralysis of the abductor pollicis brevis and the oppositor of the thumb, together with anaesthesia of the 1st to 4th fingers. The electromyography (EMG) indicated complete axonotmesis of the median nerve at the wrist. We performed debridement of all the devitalized tissue and covered the wound with Biobrane®. Ten days later, nerve repair surgery was performed using the left sural nerve divided into four grafts and sutured from the viable stump of the median nerve to the radial and ulnar digital nerves of the thumb, second and third common interdigital nerves. Also, the motor branch of the thenar eminence was identified and sutured. A fasciocutaneous anterolateral thigh flap was used to cover the soft-tissue defect, anastomosed to the radial artery outside the damaged area.
RESULTS
The postoperative period was uneventful. A year post-surgery, the EMG showed a reappearance of motor potential in the second lumbrical and an increase in reinnervation in APB. The patient presents a progressive improvement in the global function of the hand, with a recovery of sensation until the first interphalangeal joint.
CONCLUSIONS
The literature shows an elevated risk of failure in microsurgical free flap reconstruction and controversy over the ideal time for definitive coverage. The most common technique for reconstructing peripheral nerves is the use of autologous nerve grafts. The success of the graft is influenced by several factors, but especially the quality of the wound bed. Free tissue transfer creates a vascularized bed for the non-vascularized nerve grafts and allows early mobilization of the limb. A multidisciplinary treatment in a specialized Burn Center allows for adequate surgical management of HVEI, including nerve repair and soft tissue coverage.

P.130 Soft tissue and nerve reconstruction in high voltage electrical injuries: a case report and review of the literature

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre