Train surfing and other high voltage trauma: differences in injury-related mechanisms and operative outcomes after fasciotomy, amputation and soft-tissue coverage.
High-tension electrical burns sustained by 44 patients were of two types: one is caused by the intense heat of contact with an electric arc, and in the other flow of current against resistance of the deep tissues between arc wounds of entrance and exit produces deep thermal destruction. Microscopic studies in nine patients support the conclusions that such high-tension burns are thermal injuries, that the tissue destruction is not uniform, and that the slow evolution of unexcised wound reflects the admixture of areas of varying tissue viability which may become infected. An aggressive surgical approach designed to minimize tissue loss, avoid infection, and close wounds as early as possible was guided by intraoperative and later microscopic determinations of tissue viability. Despite a high amputation rate in our patients, it was avoided in the upper extremity in three patients, and maximal length of extremities was preserved in seven others. The use of microscopic analysis is recommended to determine the viability of tissues in thermal burns.