High-Voltage Electrical Burns: deep tissue injury, compartment syndrome, and reconstruction - narrative review

Abstract

Introduction: High-voltage electrical injuries may destroy muscles, vessels, and nerves beyond the visible skin lesion, with risks of arrhythmias, rhabdomyolysis, kidney injury, and limb loss. Objective: To organize initial assessment, systemic surveillance, surgical decompression, and reconstruction after electrical burns. Methods: A critical narrative review of referral guidelines, expert consensus, and emergency and reconstructive surgery literature available through October 2026, without primary data or original statistical synthesis. Discussion: Trauma assessment and early electrocardiography should be combined with serial neurovascular examinations and appropriate renal, electrolyte, and muscle injury monitoring. Escharotomy and fasciotomy address different mechanisms of compression. Debridement should account for possible progression of deep tissue necrosis, while reconstructive coverage depends on vascular viability and the exposure of critical structures. Conclusion: Recognition of occult injury, prevention of systemic complications, and staged functional reconstruction are more important than the initial skin appearance. Interpretation must account for heterogeneity across studies, individual anatomy, local resources, and the limitations of available evidence. Clinical decisions therefore require context-sensitive judgment rather than unsupported generalizations about the comparative superiority of a single approach.