Baylan Joseph M, Chambers J Alan, McMullin Neil, Fletcher John L, Sinha Indranil, Lundy Jonathan, King Booker T, Chan Rodney K
Department of Surgery, Scott and White Hospital Systems, Temple, TX, United States.
Walter Reed National Military Medical Center, Washington, DC, United States.
Burns. 2016 Mar;42(2):e24-30. doi: 10.1016/j.burns.2015.06.020. Epub 2015 Dec 2.
In the severely burned patient, coverage of exposed bone in the dorsal ulnar wrist can be a difficult problem. This is especially challenging in patients with a high percentage total body surface area (TBSA) where donor flaps can be scarce. The use of previously burned and/or recently grafted skin as flaps is an option. It has been postulated that use of previously burned skin can result in higher rates of local or distant flap failures. The reverse posterior interosseous flap (PIF) is an axial flap, based on the retrograde posterior interosseous artery, to provide coverage of the hand. Here we describe utilization of the PIF, using previously burned and/or recently grafted skin for coverage of dorsal ulnar wrist defects.
This is a case series of three patients, with extensive burns (range 35-83%TBSA), where defects of the dorsal ulnar wrist necessitated coverage. Each patient underwent PIF(s) utilizing previously burned and/or grafted skin, all within three months after their initial burn event.
Case 1: 28 year old male who suffered 35% TBSA via blast mechanism developed a chronic open wound over the dorsal ulnar wrist with exposed tendon. The patient successfully underwent a left PIF using previously grafted skin. Case 2: 23 year old male with 83% TBSA. Bilateral ulnar styloids were exposed. PIFs were performed bilaterally, using previously burned and recently grafted skin. Coverage was successful but received leech therapy post-operatively for venous congestion. Case 3: 37 year old male with 52% TBSA, with the most severe burns isolated to his bilateral upper extremities; the ulnar head was exposed. The posterior interroseous artery was explored and PIF was attempted, but there was no retrograde flow in the distal artery due to a deeper injury than previously recognized. The patient ultimately underwent a pedicled abdominal flap for coverage.
Defects of the distal ulnar wrist after deep and extensive burns can be problematic. Use of the reverse PIF using previously burned skin, even those that has just been recently grafted is a viable option for this difficult patient population. However, it may not be possible in all patients. Vigilance and early intervention for post-operative venous congestion are important.
在严重烧伤患者中，覆盖尺侧腕背侧暴露的骨骼可能是一个难题。在全身表面积（TBSA）百分比高的患者中，这一挑战尤为突出，因为供体皮瓣可能稀缺。使用先前烧伤和/或近期移植的皮肤作为皮瓣是一种选择。据推测，使用先前烧伤的皮肤可能导致局部或远处皮瓣失败率更高。逆行骨间后皮瓣（PIF）是一种轴型皮瓣，基于逆行骨间后动脉，用于覆盖手部。在此，我们描述了利用PIF，使用先前烧伤和/或近期移植的皮肤覆盖尺侧腕背侧缺损的情况。
这是一个包含三名患者的病例系列，患者均有大面积烧伤（TBSA范围为35 - 83%），尺侧腕背侧缺损需要覆盖。每名患者均在初次烧伤事件后的三个月内，利用先前烧伤和/或移植的皮肤进行了PIF手术。
病例1：一名28岁男性，因爆炸机制导致TBSA达35%，在尺侧腕背侧出现慢性开放性伤口，伴有肌腱外露。患者成功接受了使用先前移植皮肤的左侧PIF手术。病例2：一名23岁男性，TBSA为83%。双侧尺骨茎突外露。双侧进行了PIF手术，使用了先前烧伤和近期移植的皮肤。覆盖成功，但术后因静脉淤血接受了水蛭疗法。病例3：一名37岁男性，TBSA为52%，最严重的烧伤集中在双侧上肢；尺骨头外露。探查骨间后动脉并尝试进行PIF手术，但由于损伤比先前认识到的更深，远端动脉无逆行血流。患者最终接受了带蒂腹部皮瓣覆盖。
深度和大面积烧伤后尺侧腕远端的缺损可能很棘手。对于这一困难的患者群体，使用先前烧伤的皮肤，即使是刚移植不久的皮肤进行逆行PIF手术是一种可行的选择。然而，并非所有患者都适用。对术后静脉淤血保持警惕并进行早期干预很重要。
