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Electric burn injury to the hand!

The story we were given was that this man accidentally grabbed a power line at a construction site.

The resulting electric shock mummified all five fingers, which had to be removed.

Burn injury can also result from an electric current that passes between the power source and the anatomic point of contact (entrance wound), and between the patient (exit wound) and the grounding mechanism, causing hidden destruction of deeper tissues.

Such electrically conductive burns are simply thermal injuries occurring when the electric energy is converted to thermal energy. Resistance of living tissue changes as the current flows.

Skin represents an initial barrier to flow of current and serves as insulation to the deeper tissues. Once an electric current contacts skin, the amperage rises slowly, followed by an abrupt and rapid climb. This change in flow coincides with a progressive decline in skin resistance.

Once this skin resistance breaks down, current enters the underlying tissue whose internal tissue resistance, with the exception of bone, is negligible to current flow.

Within seconds, electric current in tissue peaks and then falls precipitously to zero. Current ceases to flow when the heat-producing tissue carbonization (eschar) volatilizes tissue fluid. Termination of current flow is signaled by the appearance of an arc or flash.

High-voltage electric entry wounds are charred, centrally depressed, and leathery in appearance, while exit wounds are more likely to "explode" as the charge exits. They often leave a black metallic coating on the skin, clearly seen above.

At this point, where does your treatment focus start?

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