What is the likely degree of burn in a 15-year-old boy who suffered a high voltage electrical injury?

High Voltage Electrical Burns in a 15-Year-Old Boy

High voltage electrical burns in a 15-year-old boy would most likely be classified as 4th degree burns (involving epidermis, dermis, and deeper structures including muscle, bone, and tendons). 1

Characteristics of High Voltage Electrical Burns

High voltage electrical injuries (>1000 volts) cause significantly more severe damage than typical thermal burns due to their unique mechanisms of injury:

• Current traverses through the body causing internal damage along its pathway
• Burns appear at both entry and exit points
• Extensive deep tissue damage occurs beneath seemingly minor surface burns 1, 2

Tissue Damage Pattern

High voltage electrical burns cause damage through multiple mechanisms:

• Direct current flow damage
• Arc injuries
• Thermal burns from ignited clothing/materials
• Deep tissue destruction due to electrical resistance 2

Different tissues have varying resistance to electricity:

• Bone (highest resistance) → generates significant heat
• Muscle and nerves (lower resistance) → extensive damage
• Blood vessels → thrombosis and necrosis 2

Why These Burns Are Classified as 4th Degree

1. Depth of Injury: High voltage electrical burns typically destroy all layers of skin and extend into subcutaneous fat, muscle, and even bone 2

2. Hidden Damage: The visible external burn often represents only a small portion of the actual injury, with extensive damage to deeper structures 1, 2

3. Clinical Evidence: Studies show high voltage injuries commonly require:

   • Multiple surgical debridements of necrotic tissue
   • Amputations (18-23.6% of cases) due to deep tissue destruction
   • Complex reconstruction procedures 3, 4, 5

Clinical Implications

The management of high voltage electrical burns requires specialized care:

• Immediate assessment for compartment syndrome and need for fasciotomy
• Serial debridement of devitalized tissue
• Monitoring for myoglobinuria and acute kidney injury
• Cardiac monitoring for arrhythmias
• Neurological assessment for immediate and delayed complications 2, 3

Important Complications

• Cardiac arrhythmias
• Rhabdomyolysis with myoglobinuria
• Compartment syndrome
• Neurological damage (immediate or delayed)
• Traumatic injuries from falls or tetanic muscle contractions 2, 4

Caution

The severity of high voltage electrical burns is often underestimated initially. The "iceberg effect" means visible external burns may appear limited while concealing extensive internal damage. All victims of high voltage electrical injuries require thorough medical assessment as the extent of injury may not be immediately apparent. 1, 2

Treatment Considerations

Treatment must address both the visible burns and the hidden damage:

• Aggressive fluid resuscitation (conventional burn formulas may underestimate needs)
• Early surgical intervention for compartment syndrome
• Tissue-sparing but thorough debridement
• Complex reconstruction with skin grafts or flaps 3

In pediatric patients, special consideration must be given to preserving growth plates when amputation is necessary and planning for long-term functional outcomes. 3