Handschin A E, Jung F J, Guggenheim M, Moser V, Wedler V, Contaldo C, Kuenzi W, Giovanoli P
Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, Universitätsspital Zürich, Switzerland.
Handchir Mikrochir Plast Chir. 2007 Oct;39(5):345-9. doi: 10.1055/s-2007-965721.
PURPOSE/BACKGROUND: High-voltage burns represent a challenging surgical entity. Compared to conventional burns, these injuries are characterized by an increased morbidity and worse potential for rehabilitation. The aim of the present study was to analyse the management of high-voltage injuries during the early posttraumatic period with special emphasis on the surgical procedures.
PATIENTS/MATERIAL AND METHOD: We retrospectively evaluated the medical records of patients with electrical injuries treated from 1995 - 2007. A total of 61 patients (57 men, 4 females, mean age: 34 +/- 13 years) with high-voltage burns was included for analysis.
The majority of high-voltage burns was work-related (75 %). The mean total burn area was 35 % of the total body surface, with a mean of 29 % deep burns. An average of 4.8 +/- 4 operations were performed per patient (range: 1 - 23 operations). Surgical procedures included repeated debridement/necrectomy (100 % of all patients), early escharotomy/fasciotomy (47.5 %), and amputations (18 %). 14 patients (23 %) underwent reconstructive surgery using either local or free flaps. The mortality rate was 15 %.
The surgical management of high-voltage burns is characterised by repetitive debridements and necrectomies. Despite an aggressive approach to remove necrotic tissue, the mortality in this type of injury is considerably high. Limb salvage may be achieved with the use of free microvascular flaps. However, an amputation of necrotic extremities must be considered in the copresence of septic complications.
目的/背景：高压烧伤是一种具有挑战性的外科疾病。与传统烧伤相比，这些损伤的特点是发病率增加，康复潜力更差。本研究的目的是分析创伤后早期高压损伤的处理，特别强调手术操作。
患者/材料与方法：我们回顾性评估了1995年至2007年期间接受电损伤治疗患者的病历。共纳入61例高压烧伤患者（57例男性，4例女性，平均年龄：34±13岁）进行分析。
大多数高压烧伤与工作相关（75%）。平均总烧伤面积为全身表面积的35%，平均深度烧伤面积为29%。每位患者平均接受4.8±4次手术（范围：1 - 23次手术）。手术操作包括反复清创/坏死组织切除（所有患者的100%）、早期焦痂切开术/筋膜切开术（47.5%）和截肢术（18%）。14例患者（23%）采用局部或游离皮瓣进行了重建手术。死亡率为15%。
高压烧伤的外科处理特点是反复清创和坏死组织切除。尽管采取积极措施清除坏死组织，但这类损伤的死亡率相当高。使用游离微血管皮瓣可实现肢体保全。然而，在存在脓毒症并发症的情况下，必须考虑对坏死肢体进行截肢。
