A Multidisciplinary Limb Salvage Strategy for Complex Bilateral High-Voltage Electrical Burns Injury of the Ankle

Abstract

Background: High-voltage electrical injuries, though less common than domestic electrocution in developing countries, can be devastating, particularly when involving bilateral lower limbs. These injuries pose significant challenges due to prolonged immobilisation and complications such as deep vein thrombosis, pressure ulcers, and potential limb loss.
Case Presentation: We report the case of a 60-year-old male who sustained bilateral ankle high-voltage electrical burns following accidental contact with an overhead transmission line. The injuries resulted in extensive soft-tissue loss and exposed joints.
Management: The patient was managed through a multidisciplinary approach involving the burns team, orthopaedic surgeons, rehabilitation specialists, and social counsellors. The treatment strategy included serial debridements, negative pressure wound therapy (NPWT), skeletal stabilisation using hybrid Ilizarov external fixators, and staged soft-tissue reconstruction with a reverse sural artery flap and split-thickness skin grafting.
Outcome: The limb salvage outcome was successful, with progressive wound healing and functional recovery. The coordinated involvement of multiple specialties played a pivotal role in managing this complex case.
Conclusion: This case highlights the importance of early multidisciplinary collaboration in the successful management of high-voltage electrical injuries, particularly those involving bilateral lower extremities with joint exposure.