High-voltage electrical injury: electron microscopic findings of injured vessel, nerve, and muscle.

Bilateral legs damaged by high-voltage electrical injury were treated by amputation and a free thin rectus abdominis myocutaneous flap with reduced muscle. Damaged arteries at 2 months after injury showed disappearance of endothelium, and a decreased number and morphological changes in smooth-muscle cells. Injured nerves and muscles showed early regenerating processes after total degeneration, and no progressive muscular necrosis. These results suggest that severe degeneration of the neurovascular bundle and muscle is unavoidable in high-voltage electrical injuries of the extremities. Therefore, early amputation, sequential debridement, late coverage by a flap, and prolonged rehabilitation are required in this injury.