Timing and Outcomes of Free Flap Reconstruction in High-Voltage Electrical Burns of the Extremities

Background High-voltage electrical burns of the extremities often result in deep tissue destruction with exposure of vital structures, necessitating free flap reconstruction. However, the optimal timing for reconstruction remains uncertain, particularly in the presence of evolving tissue viability. Methods This retrospective study included 23 patients with full-thickness high-voltage electrical burns involving the extremities who underwent free flap reconstruction. Patients were divided into two groups based on timing of flap coverage: early (21 days, after at least 2 debridements). Outcomes assessed included flap survival, complications, reexploration rate, operative time, and hospital stay. Results The cohort was predominantly male (male-to-female ratio of 10:1) with an age range of 15 to 60 years. The upper limb was involved in 16 patients; and the lower limb, in 7. The overall flap survival rate was 87% (20/23). Flap failure occurred in 1 of 6 early cases and 2 of 17 delayed cases ( P = 1.00). Complications were more common in the early group (66.7%) compared to the delayed group (47.1%) but were not statistically significant ( P = 0.34). Four flaps required reexploration, with one successfully salvaged. Operative time and hospital stay were slightly longer in the delayed group but did not reach statistical significance. Conclusion Free flap reconstruction remains a reliable option for limb salvage in high-voltage electrical burns. A biologically timed approach—delaying reconstruction until tissue demarcation and vascular stability—may minimize complications while maintaining high flap survival rates.