Reconstructive Surgery for High-voltage Injury of Genitoperineal Area and Upper Extremities: The Uromanual Trauma Concept

Reconstruction of tissue defects resulting from high-voltage injuries remains a serious issue in plastic surgery. For many years it has been solved by applying autologous reconstruction with rotated and revascularized flaps. We present a series outlining reconstructive practices in treatment of patients with high-voltage “uromanual” injuries. These types of injuries include a group of upper extremities and genitoperineal high-voltage trauma due to urination on an electrical source, which are rarely discussed in the literature. This study aimed to describe the algorithm of perioperative care and surgical treatment in patients with high-voltage uromanual trauma. Three male patients (mean age 26.3 years, range: 20–35 years) with traumatic injury of the genital area and the upper extremities due to high-voltage injury underwent reconstruction with a one-stage repair of defects. In one patient, the defect of the left upper extremity was eliminated by microsurgical autotransplantation of musculocutaneous thoracodorsal artery perforator flap. The genitoperineal region was repaired using rotated scrotal flaps. In two other cases, phalloplasty with a revascularized myocutaneous thoracodorsal artery perforator flap was followed by urethroplasty with a prefabricated radial forearm free flap. Hand deformities were eliminated using split-thickness skin autografts. All flaps survived. No complications were observed in the autograft harvesting areas. All cases showed good aesthetic and functional postoperative outcomes. Management of uromanual injuries should include one-stage reconstruction of upper extremities and genitoperineal defects for restoration of satisfying functional and aesthetic components crucial for patient’s quality of life and socialization.