Shen Yu-ming, Hu Xiao-hua, Mi Hui-ru, Yu Dong-ning, Qin Feng-jun, Chen Hui, Wang Hao, Zhang Guo-an
Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Shao Shang Za Zhi. 2011 Jun;27(3):173-7.
To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs.
Fifty-four patients (50 males and 4 females, aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm, forearm-elbow-upper arm, shoulder-axillary region, ankle-foot, lower leg, around the knee, thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients, certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated, among them forearm amputation was performed for 5 upper limbs with necrosis, with preservation of elbow joints, and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps; 1 upper limb with upper arm amputated, with preservation of shoulder joint, was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement, in which 3 brachial arteries, 1 vein, 1 brachial artery and vein were reconstructed in 5 wrist wounds, artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up.
Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction, abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting, in which 2 wounds healed after removal of necrotic tissue followed by closure with suture, and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds), elbow (1 wound), ankle-foot (2 wounds), and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting, and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months, the skin flaps survived with satisfactory appearance and texture.
Early extensive compartment release through fasciectomies and escharectomies, early debridement, early vascular grafting, early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.
总结四肢高压电烧伤早期治疗的经验。
2003年1月至2010年12月，我院烧伤病房收治54例四肢高压电烧伤患者（男50例，女4例，年龄10～56岁），共97条肢体（上肢67条，下肢30条）。其中腕部 - 前臂、前臂 - 肘 - 上臂、肩部 - 腋窝区、踝部 - 足部、小腿、膝关节周围、大腿 - 腹股沟区共119处烧伤创面于伤后10天内行切开减压术。在患者全身情况相对稳定的前提下，进行如下手术操作：（1）截肢并修复16条肢体的16处创面，其中5例上肢坏死行前臂截肢，保留肘关节，残端创面用带蒂背阔肌肌皮瓣修复；1例上臂截肢保留肩关节，用带蒂背阔肌肌皮瓣修复。（2）95处创面早期清创后用各种血运丰富的组织瓣覆盖，其中5例腕部创面重建3条肱动脉、1条静脉、1条肱动脉和静脉，1例肱动脉损伤的肘部创面行动脉重建。（3）8处创面行游离植皮。观察创面愈合情况并随访。
16条肢体截肢并修复后创面愈合。5例腕部创面血管重建后手部血运和（或）静脉回流恢复。1例肱动脉损伤患者动脉重建后血运丰富，避免了截肢。5例植皮后组织瓣远端坏死，其中2例清除坏死组织后缝合愈合，3例清创后游离植皮愈合。腕部（5处）、肘部（1处）、踝部 - 足部（2处）组织瓣感染，清创缝合后愈合。其余组织瓣植皮后成活。6处创面植皮后愈合。2处创面植皮后部分坏死，二次植皮后愈合。37例患者随访6～12个月，皮瓣成活，外观及质地满意。
早期广泛切开筋膜减压及焦痂切除、早期清创、早期血管移植、早期采用现代修复重建外科技术覆盖创面是治疗四肢高压电烧伤的合理选择。
