Early free tissue transfer for extremity reconstruction following high-voltage electrical burn injuries.

We compared the effectiveness of free tissue transfer in repairing high-voltage electrical extremity injuries with conventional multistage procedures. Patients were matched for age, sex, level of injury, voltage, and burn surface area; results were compared using the paired Student T test. Free tissue transfer was performed a mean of 19.1 +/- 10.6 days after the injury occurred, and definitive wound closure and limb salvage were achieved in 87.5% of patients after a mean of 23.0 +/- 9.1 days after the injury. The overall flap survival rate was 80% (13 of 15 flaps). Three flaps failed, two of which were lower-limb flaps at the knee level used for patients with injuries to both upper and lower limbs. Both patients required upper and lower proximal ipsilateral limb amputations. One upper-extremity flap failed after pedicle avulsion 4 days after surgery, but a second free tissue transfer was successful in salvaging this limb 4 days later. The number of surgeries, time required to achieve wound closure, and length of hospitalization were all statistically significantly lower in the free flap group compared with those in the conventional treatment group.