Parrett Brian M, Pomahac Bohdan, Demling Robert H, Orgill Dennis P
Division of Plastic & Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Burn Care Res. 2006 Jan-Feb;27(1):34-9. doi: 10.1097/01.bcr.0000192265.20514.c5.
Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%). A mean of eight operations were required for limb salvage. Six free-tissue transfers, 2 fillet flaps, 14 local flaps, and multiple skin grafts were performed. Five patients underwent tibial burring for granulation tissue stimulation, and the subatmospheric pressure device was used in eight patients. Seven limb amputations (18%) were required in four patients, and 76% of patients were ambulatory on follow-up. The mean hospital stay was 76 days with high rates of cellulitis, deep vein thrombosis, and bacteremia. Patients treated with flap closure had a significant decrease in the number of operations required for limb salvage. Fourth-degree lower-extremity burns require multistage reconstructive procedures using multiple levels of the reconstructive ladder but limb salvage is possible in a majority of cases.
四肢Ⅳ度烧伤累及肌肉、肌腱和骨骼，常导致截肢或严重功能障碍。我们报告了一家城市烧伤中心在1995年至2004年这10年间治疗下肢Ⅳ度烧伤的经验，以描述治疗方法和结果。21例患者（40条肢体），平均年龄45岁，接受了下肢Ⅳ度烧伤治疗，平均肢体烧伤面积为24%总体表面积（范围为2% - 36%），平均Ⅳ度烧伤面积为9%总体表面积（范围为2% - 18%）。为挽救肢体平均需要进行8次手术。进行了6次游离组织移植、2次鱼口状皮瓣移植、14次局部皮瓣移植以及多次植皮。5例患者接受了胫骨钻孔以刺激肉芽组织生长，8例患者使用了负压装置。4例患者中有7条肢体（18%）需要截肢，76%的患者在随访时可行走。平均住院时间为76天，蜂窝织炎、深静脉血栓形成和菌血症发生率较高。采用皮瓣闭合治疗的患者挽救肢体所需的手术次数显著减少。下肢Ⅳ度烧伤需要使用多个重建阶梯层次进行多阶段重建手术，但在大多数情况下肢体挽救是可行的。
