Ofer Nina, Baumeister Steffen, Megerle Kai, Germann Günter, Sauerbier Michael
Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen, Germany.
J Plast Reconstr Aesthet Surg. 2007;60(7):724-30. doi: 10.1016/j.bjps.2006.12.010. Epub 2007 May 4.
Microvascular reconstruction is rarely indicated in burn injuries. As the versatility and variability of free flaps have increased significantly during recent years so, the indications for this procedure have been expanded for limb salvage after electrical injuries.
We report retrospectively the results of 26 free flaps for extremity reconstruction in 19 patients suffering from severe electrical burn injuries. Nine different free flap types were used. On the basis of this experience we were able to establish reconstructive principles in electrical injuries pertinent to the timing of reconstruction procedures.
Early coverage with muscular flaps was the most frequently used type of reconstruction. At a later stage of the treatment course reconstruction with cutaneous or fascial flaps was the preferred method; for the reconstruction of complex or multistructural defects (n=3) combined 'chimeric' flaps were used. Overall, the flap failure rate was 15% (n=4). Interestingly, there was a relationship between flap failure rate and timing of the procedure. All the flap failures occurred within 5-21 days after trauma. No flap failure occurred during secondary reconstruction.
Our data demonstrate that electrical burn injuries are distinct entities requiring individual reconstructive solutions for limb salvage. Even if our flap failure rate is relatively high it should not be forgotten that this type of reconstruction represents an opportunity for limb salvage as opposed to early amputation.
微血管重建术在烧伤中很少应用。近年来，随着游离皮瓣的多样性和可变性显著增加，该手术在电损伤后肢体挽救中的适应证也有所扩大。
我们回顾性报告了19例严重电烧伤患者行26例游离皮瓣进行肢体重建的结果。使用了9种不同类型的游离皮瓣。基于这一经验，我们能够确立与重建手术时机相关的电损伤重建原则。
早期用肌皮瓣覆盖是最常用的重建方式。在治疗后期，采用皮瓣或筋膜瓣重建是首选方法；对于复杂或多结构缺损的重建（n = 3），使用了联合“嵌合”皮瓣。总体而言，皮瓣失败率为15%（n = 4）。有趣的是，皮瓣失败率与手术时机之间存在关联。所有皮瓣失败均发生在创伤后5至21天内。二次重建期间未发生皮瓣失败。
我们的数据表明，电烧伤是独特的损伤类型，需要针对肢体挽救采取个体化的重建解决方案。即使我们的皮瓣失败率相对较高，但不应忘记，与早期截肢相比，这种重建方式为肢体挽救提供了机会。
