The Roles of Fasciotomy and Peripheral Nerve Decompression in Electric Burn Patients: A Systematic Review and Meta-Analysis

Introduction: Peripheral nerves preferentially conduct electricity due to their low resistance as compared with other tissues, predisposing them to injury from electrical burns. The purpose of this study was to investigate the efficacy of fasciotomy and peripheral nerve decompression on peripheral nerves after electric injury. Methods: A systematic review of patients who had sustained electric burn injuries was performed according to PRISMA Guidelines. Incidence, demographic and injury characteristics, and patterns of symptoms were analyzed. Meta-analysis was performed to examine changes from baseline from nerve conduction studies. Outcomes for fasciotomy and various nerve decompressions were also analyzed. Results: Of the 119 articles included in for systematic review, 16,773 patients were included. Most available studies the case reports or case series that yielded moderate- to poor-quality evidence. The median follow-up of the included patients was 44 weeks (IQR 15-97 weeks). Patients who underwent fasciotomy had significantly lower rates of peripheral neuropathy than those who did not by the last recorded follow-up (45% vs. 92%, p < 0.0001). Patients who underwent peripheral nerve decompression after 30 days of injury had lower rates of peripheral neuropathy at the last follow-up compared with those who underwent decompression within 30 days (21% vs. 53%, p < 0.0001). Conclusions: A paucity of high-quality evidence exists to standardize management recommendations for peripheral nerve injury; however, of what literature does exist, it seems that fasciotomy and nerve decompressions are associated with improved peripheral nerve function in the long-term, but nerve decompression likely provides more benefit when performed if symptoms persist one-year post-injury.