Electrical burn on finger
Michael Cheung1, Bish Soliman1, Varun Harish1, 1Royal North Shore Hospital
Abstract
Background
Electrical burn reconstruction is challenging especially on digits. In cases where tendon and joint are exposed, traditional approach with skin graft reconstruction is not an option. Electrical injuries are associated with vascular injuries which can limit the use of locoregional flap and free flap reconstruction. Wang and Zoh (1983) studied histology in electrically damaged vessels and found that damage to vascular wall from adventitia to intima inevitably leads to thrombosis and obstruction of blood flow. Here we present a case of a successful use of homodigital flap based on preoperative duplex ultrasonography on a finger electrical burn injury.
Case
A 25 year old male farmer sustained electrical burn on his left middle finger radial tip from a 240 volt power outlet at home. He lived in a rural area which is 7 hours away from a metropolitan burn referral centre. His treatment was delayed due to limited access to medical service and appropriate dressing. He then presented to a burn centre with an infected and necrotic finger tip 8 days later and underwent washout and debridement in theatre. The radial finger tip defect measured 14mm x 10mm. A subsequent vascular arterial duplex scan confirmed presence of transverse communicating arterial branches and a diminished flow in radial digital artery towards the tip. His finger tip was reconstructed with a reversed homodigital island flap 2 days later. After 4 weeks of physiotherapy, he returned to work with full duty.
Reference
WANG, X. W. & ZOH, W. H. 1983. Vascular injuries in electrical burns–the pathologic basis for mechanism of injury. Burns Incl Therm Inj, 9, 335-8.
Biography
Plastic Surgery and Burns Registrar (unaccredited) at Royal North Shore Hospital