The complex pathophysiology of electrical injury is caused by several mechanisms which are superimposed and cumulative in action. Existing empirical guidelines are only partially compatible with the results of recent studies. The significance of the joule effect, theories about progressive tissue necrosis, and the traditional surgical approach should be reviewed in view of electroporation and anatomical arrangements. The quality of long-term treatment results and the consistently high rate of amputations have prompted the development of alternative surgical options.