Efficacy of Digital Subtraction Angiography in Identifying Arterial Injuries and Guiding Treatment in High-Voltage Electrical Burns to the Wrist: A Retrospective Analysis

OBJECTIVE: This study aimed to evaluate the efficacy of digital subtraction angiography (DSA) in detecting and classifying arterial injuries associated with high-voltage electrical burns (HVEBs) to the wrists and its utility in informing clinical decision-making. METHODS: A retrospective analysis of 32 cases with wrist injuries from HVEBs, with DSA exams conducted from January 1, 2019, to December 30, 2022. Forty-six limbs were categorized into type A (stable perfusion), type B (unstable perfusion), and type C (complete occlusion) based on DSA findings. Additional data included concurrent injuries, emergency interventions, time to surgery, flap type, number of surgeries, complications, and prognosis. RESULTS: DSA examinations were performed an average of 5.96 days postinjury. Type A included 17 limbs with stable radial artery perfusion and 2 limbs with stable ulnar artery perfusion. All limbs were successfully salvaged through the timely implementation of fasciotomy, comprehensive debridement, and early flap coverage. Type B included 15 limbs, 13 salvaged with fasciotomy, vascular reconstruction, and flap coverage; 2 limbs required amputation due to late-onset infection of the distal radius and ulna. Type C was identified in 12 limbs, with 11 requiring amputations, whereas limb salvage was achieved in 1 case through active vascular reconstruction and flap coverage. CONCLUSIONS: DSA is effective for assessing arterial stenosis and occlusion in HVEBs to the wrist, guiding limb salvage strategies. Supplementary diagnostics are necessary to enhance DSA in treatment planning for HVEBs affecting the wrist.