Asian Journal of Research in Surgery

High-voltage electrical burns may cause progressive damage to deep tissues despite an initially limited clinical appearance, making decisions about limb preservation difficult. This case report describes the clinical course and management of a 28-year-old construction worker who sustained an occupational electrical injury when a metal bar held in both hands contacted a 13,000-V conductor. The affected total body surface area was estimated at 15%, with severe burns involving both upper limbs and an electrical exit wound on the left foot. On admission, he was conscious, alert and oriented, without chest pain or palpitations. Initial management included fluid resuscitation, monitoring of vital signs and urine output, emergency bilateral upper-limb fasciotomies and carpal tunnel release. Despite early decompression, necrosis progressed in both hands. During the second week after injury, dark-coloured urine was observed, and serum creatine phosphokinase and lactate dehydrogenase levels were markedly elevated, consistent with ongoing muscle necrosis and raising concern about rhabdomyolysis. Bilateral forearm amputation was subsequently performed because of progressive tissue destruction and the risk of systemic complications. Following amputation, the patient underwent bilateral myoelectric prosthetic fitting and regained a satisfactory degree of functional autonomy. This case illustrates the difficulty of assessing the progression of deep tissue injury after high-voltage exposure and the importance of considering both systemic risks and subsequent rehabilitation when determining the timing and level of amputation.