Revascularize or Amputate? Underrated Arterial Damage in High-Voltage Electrocution: A Literature-Informed Clinical Perspective.

High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the risks of hemorrhage, infection, and repair failure. A comprehensive literature review was performed using PubMed, Scopus, and Cochrane databases with predefined MeSH terms and keywords related to electrocution and arterial injury. Nineteen relevant human studies were selected after screening. In addition, we present a case of high-voltage upper limb injury in which an arterial interposition graft using the deep inferior epigastric artery (DIEA) was performed in an attempt to maintain hand perfusion. Most published reports describe venous grafts-the most commonly used option-or flow-through flaps as reconstructive options. To date, no previous cases have reported the use of arterial grafts in this context. Arterial injuries may present acutely or subacutely, and a variety of repair techniques have been described, without clear evidence favoring one approach over another. In our case, despite technically successful placement of a DIEA arterial graft following radial artery rupture, early thrombosis and distal ischemia occurred, ultimately resulting in limb loss. Vascular injury from electrocution is often more extensive than macroscopically evident. Reconstructive attempts should be considered only in stable patients, especially when preserving the dominant limb in young individuals. Although arterial grafts offer structural advantages, they may not overcome the systemic and local damage induced by electrocution. Further research is needed to define clearer guidelines for vascular repair versus amputation in these complex scenarios.