Progressive Tissue Loss and Arterial Degeneration Suggesting a Delayed Muscle–Vascular Injury Pattern After Electrical Burn

Summary:

High-voltage electrical injuries are associated with severe deep tissue damage that is often difficult to assess based on cutaneous findings alone. Vascular injury may contribute to delayed tissue necrosis and complicate reconstruction, but its clinical significance remains incompletely understood. We report a case of progressive soft-tissue loss with histopathologically confirmed arterial wall degeneration following 275-kV electrical injury and discuss its reconstructive implications. A 50-year-old electrical maintenance worker sustained a 275-kV electrical injury involving the left upper extremity. Despite repeated debridement and skin grafting, progressive deep muscle necrosis developed, requiring additional excisions. During one of the subsequent debridements, the brachial artery, which was encased in necrotic tissue, was injured and required reconstruction with an interposition vein graft. Histopathological examination later demonstrated arterial degeneration, including intimal thickening, medial fibrosis, and elastic lamina fragmentation, despite the absence of major arterial abnormalities on preoperative imaging. Reconstruction was further complicated by re-occlusion of the reconstructed brachial artery, limiting functional restoration. Elbow flexion was ultimately reconstructed using a pedicled flap, although overall functional recovery remained limited. This case suggests the possibility of a delayed muscle–vascular injury pattern following severe electrical injury, characterized by progressive tissue loss and arterial wall degeneration. Such changes may complicate assessment of tissue viability and reconstructive planning. Awareness of potential vascular involvement within the vicinity of injury may be important when planning reconstruction after high-voltage electrical burns.