A 25 years-old previously healthy male shipyard technician was repairing a 1200 V alternating current electrical generator when it exploded. His right hand was touching the circuit box at the time of blast, but he denied prolonged contact or being flung. He sustained 16% total body surface area (TBSA) burns to his face as well as both arms and hands (Fig. 1).
Fluid resuscitation was commenced, and he underwent debridement of his upper limb burns (including escharotomy of his right forearm) and application of biosynthetic Biobrane  dressings (UDL Laboratories, Rockford, IL) to his face (Fig. 2A). Immediately after surgery, he complained of worsening, severe right hand pain, and an emergent fasciotomy was done for presumptive compartment syndrome (Fig. 2B). He also developed AKI with hyperkalaemia, a rising creatine kinase and myoglobinuria. Haemodialysis was initiated as his urine output failed to improve despite aggressive fluid boluses, mannitol diuresis and urinary alkalinisation. His AKI resolved after two weeks along with correction of his metabolic abnormalities and renal replacement therapy (RRT) was withdrawn.
Serial debridement was performed until his upper limb wounds were clean and the full demarcation of the depth and extent of his injuries had become apparent. Autologous split-thickness skin-grafting was performed; the dorsum of his right hand ultimately required coverage with a groin flap (Fig. 3). He was discharged after 4 months and returned to work after a year of intensive rehabilitation.