gms | German Medical Science

Objectives: The purpose of this paper is to highlight that the electrocution produces massive tissue distructions which require several and complex surgical interventions. Finding the appropriate surgical technique in these cases is, sometimes, a true challenge for the Hand Surgeon. Due to the modest surface of skin available in the hand, massive cutaneous and vascular distructions, the usage of microsurgical techniques isn't always possible. Despite the surgical efforts, the functionality and, especially, the esthetics, is only satisfactory in many cases.

Method: We present the case of a 32-year old male patient with autolytic electrocution lesions (the patient connected to an electrical power source – 220 volts for 10–15 minutes, through 2 electrical cables passing the both wrist joints). He presented with cutaneous necrosis of the dorsal aspect of the F1 and F2 of the thumb, including the interphalangeal joint, soft tissue necrosis of the dorsal aspect of F2 and F3 of the 3^rd and 4^th fingers with bone exposure in the right hand (dominant hand) and cutaneous necrosis of the dorsal aspect of F1 and F2 of the 2^nd, 3^rd and 4^th fingers in the left hand. In order to cover the defects in the right hand, we used local and regional flaps: cerf-volant flap for the dorsal face of the thumb and revers Brunelli flaps for the defects in the 3^rd and 4^th fingers. At 1 month we reconstructed the interphalangeal thumb joint with a Mathys joint prosthesis and we grafted the extensor pollicis longus. In the left hand we covered the defect with a full-thickness skin graft. All the surgeries were performed after a psychiatric consult and treatment. Due to the psychiatric state of the patient, we didn't considered a microsurgical reconstruction as a surgical solution.

Results: All flaps viability and integration were good, without any immediate or at distance complication. The same good surgical result was obtained in the case of the thumb, but, due to a vicious collaboration with the patient, we can score the functional recovery of the interphalangeal thumb joint only as satisfactory.

Conclusion: Electrocution produces massive deep tissues damage, which require serial surgical interventions, mostly out of the complex ones. Using the microsurgical techniques is not possible when we deal with a limited surface of local skin which can be used in the reconstruction, with extensive vascular damage or when we deal with an instable patient – this is when a Hand Surgeon mission becomes one of the most difficult.