Beyond the Charred Surface: Evidence-Based Salvage of the Glans Penis and Digital Units in High-Voltage Electrical Trauma

Introduction: High-voltage electrical burns are devastating injuries that trigger a progressive necrotic process known as the "iceberg effect," where deep tissue damage far exceeds superficial findings. When these injuries involve specialized aesthetic units such as the genitalia and hands, the reconstructive challenge is extreme due to the risk of irreversible functional loss. Objective: To report a multidisciplinary salvage strategy in a young patient with multi-focal high-voltage necrosis, emphasizing the role of advanced vascular imaging to avoid radical amputations. Case Presentation: A 23-year-old male was admitted following a high-voltage electrical accident. Initial examination revealed third-degree burns on the left wrist, the third finger, and the penoscrotal region. Admission labs showed a severe inflammatory state with a CRP of 22.32 mg/dL and an ESR of 60 mm/hr. UroCT identified reactive hydrocele and bilateral pleural effusion, while systemic complications included a delayed renal contrast elimination and early signs of sepsis. Despite the charred appearance of the glans, Penile Color Doppler demonstrated preserved cavernous artery velocities (39–55 cm/sec), justifying a conservative approach. The clinical course was complicated by multi-resistant infections involving E. coli, E. faecalis, and Candida albicans. Management consisted of a suprapubic cystostomy, targeted antimicrobial therapy, and staged debridements including a specialized glans resection and a digital disarticulation. Conclusions: Early specialized intervention and the use of vascular mapping allowed for the salvage of the corpora cavernosa and the majority of the phallic length. A staged approach is essential to preserve functional and aesthetic units in catastrophic electrical trauma.