Over the past decade, the Firefighters'
Burn Treatment Unit of the University of Alberta Hospital in Edmonton, Alberta, Canada, has treated 1399 inpatients suffering from thermal injury. Regional
burn care is provided in a 10-bed intensive care unit with 18 plastic surgery reconstructive beds for a large referral region of central and northern Alberta, portions of the Northwest Territories, and neighboring provinces of British Columbia and Saskatchewan. Of the total
burn inpatients during this period, 74 electrical
injuries were treated (5.3% of all admissions): 71 were males (95.9%) and 3 females (4.1%). The mean age of all patients was 33.9 +/- 12.6 years (range 1-67). Compared to our general population of thermally injured patients, those with electrical
injuries had smaller
injuries [9.9 +/- 12.9% TBSA (range 1-65) versus 15.1 +/- 10.1], shorter length of hospitalization [18.6 +/- 7.3 days (range 1-80) versus 26.2 +/- 0.8], and substantially lower mortality once reaching the hospital (0% versus 4%). Electrical
injuries were classified as flash in 30 cases, contact in 42 cases, and lightning in 2 cases; 74.3% of
injuries occurred during work-related activities. A total of 118 operative procedures were performed during the acute admission (1.6 procedures per patient), including 19
amputations: 12 in the upper and 7 in the lower extremity. The mean time of
amputation was 9.3 +/- 5.3 days after admission. In contact
injuries of the upper extremity, 14 patients suffered
amputations or neurologic injury that required reconstruction with free tissue transfers and nerve grafts. Long-term functional outcome of these patients using sensory testing, the Jebsen-Taylor hand function test, and
wound coverage has revealed that these patients have substantial persistent sensory impairment of their upper extremities postinjury despite reconstruction, although many remain active and functional with acceptable
wound coverage. Based on our analysis of electrical injury as it presents to one typical Canadian burn unit, our patients suffer limb loss on a delayed basis, which leads to substantial morbidity. Reconstruction of the upper extremity with microsurgical techniques after profound electrical injury has provided acceptable coverage, but in many instances is associated with poor or marginal sensory recovery limiting reemployment options for patients with upper extremity electrical
burns. Further understanding of the cellular biology of delayed tissue loss after
electric injury would offer the potential for reduction in
amputation rate and improvement in functional outcome and overall morbidity.