Secondary reconstruction of tendons and nerves improves long-term function in electrical burns of the wrist: A retrospective cohort study.

Abstract

High-voltage electrical burns can significantly damage the tendons and nerves, causing severe upper-limb dysfunction. Although early debridement and free flap coverage are proven techniques for limb salvage, the functional benefit of subsequent secondary tendon and nerve reconstruction has not been adequately investigated. Therefore, in this study, we assessed whether a systematic, staged reconstruction strategy improves long-term functional outcomes beyond those achieved with successful wound closure alone. A single-center retrospective cohort study was conducted on 42 patients (all men) with type Ⅱ/Ⅲ electrical burns who were successfully treated with free flap coverage. The patients were stratified into a reconstruction group (n = 20) who received secondary tendon/nerve procedures and a non-reconstruction group (n = 22). The primary outcome was the QuickDASH score, evaluated at least 6 months postoperatively. The groups were compared after balancing for the baseline characteristics. The two groups were comparable in terms of age, injury severity, and initial flap outcomes. The reconstruction group underwent procedures such as tendon grafting (80%), tenolysis (80%), and nerve grafting (20%), at a mean of 6.15 months postinjury. Functional assessment revealed a significantly better (p < 0.001) median QuickDASH score in the reconstruction group (26.0) compared with that in the non-reconstruction group (39.5). Successful free flap coverage provides the key biological foundation for functional restoration. A systematic, staged protocol for tendon and nerve reconstruction considerably improves long-term limb function in patients with electrical burns of the wrist. Hence, secondary functional reconstruction is indispensable in the overall treatment plan for all eligible patients.