Abstract In contrast to thermal burns, high-voltage electrical injuries frequently result in profound tissue destruction through the Joule effect, exposing the calvarium and causing full-thickness scalp abnormalities. The possibility of osteomyelitis and the avascular nature of exposed bone complicate management. The purpose of this study was to examine the functional, cosmetic, and patient-reported outcomes of different reconstructive approaches, from skin grafting to local and free flaps. A prospective observational study was conducted on 33 patients presenting with post-electric burn scalp defects at All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India, over a period of 21 months. Patients underwent reconstruction based on a hierarchical algorithm determined by the size of the defect and the viability of the bone. Interventions included split-thickness skin grafting (STSG), local flaps (rotation and transposition), and microvascular free tissue transfer. Primary endpoints were wound healing and complication rates. Secondary endpoints included functional recovery, cosmetic outcome (assessed via Likert scale), and patient satisfaction (Patient Satisfaction Index). The cohort was predominantly male (67%) with a mean age of 33 years. High-voltage electrical burns accounted for 79% of injuries. Significant bone exposure was present in 88% of cases, with 79% exhibiting an unhealthy outer table. Local rotation flaps were utilized in 36% of cases and demonstrated statistically superior outcomes compared with other modalities. Specifically, 92% of patients treated with rotation flaps achieved “good” functional recovery (p = 0.006), and 77% achieved “good” cosmesis (p < 0.001). Conversely, STSG was associated with intermediate functional results and poor cosmesis in 100% of cases applied to deep defects. Local tissue rearrangement, specifically using rotation flaps, remains the gold standard for moderate-sized post-electric burn scalp defects. It offers superior functional protection and cosmetic fidelity compared with skin grafting. While free tissue transfer is essential for massive composite defects, local flaps should be maximized whenever the surrounding scalp tissue is viable.
Nair et al. (Wed,) studied this question.