Zhao Jing-Chun, Shi Kai, Hong Lei, Jin Zheng-Hua, Zhang Xi, Gao Xin-Xin, Yu Jia-Ao
From the Burns and Plastic Reconstruction Unit, the First Hospital of Jilin University, Changchun, China.
Ann Plast Surg. 2018 Mar;80(3):232-237. doi: 10.1097/SAP.0000000000001283.
High-voltage electrical injuries usually cause extensive and devastating damages to the extremities. Timely and effective coverage of the wounds to maximally preserve the viable tissue is important for salvage and the ultimate functional outcome of the involved extremities. In this study, free anterolateral thigh flaps with a single-perforator pedicle were conducted to maximize tissue salvage and decrease late skeletal and neuromuscular complications of the involved extremities injured by high-voltage electricity.
From June 2012 to December 2015, 12 patients with high-voltage electrical injuries on the extremities were recruited. After primary or secondary debridement, free anterolateral thigh flaps with a single-perforator pedicle were used for limb salvage. Patients' clinical records, including etiology, sex, age, perforator type, defect location, duration before admission, defect and flap size, timing of reconstruction, and complications, were extracted and analyzed.
All patients were followed up ranging from 10 to 25 months, with an average follow-up of 15.9 months. Free anterolateral thigh flap with a single-perforator pedicle was performed for 12 consecutive patients with high-voltage electrical injuries. The mean time taken before the transplantation of the flap was 5.25 days, with a range from 2 to 8 days. The average size of the resultant defects after debridement was 187.0 cm (84-350 cm), the average size of the flaps was 265.3 cm (119-448 cm), and the average time of the surgical operation was 314.6 minutes (260-355 minutes). All flaps healed uneventfully without associated complications. No weakness of the donor thigh was observed in all cases.
Free anterolateral thigh flaps with a single-perforator pedicle were an effective and reliable therapeutic intervention for the management of severe high-voltage electrical injuries on the extremities.
高压电损伤通常会对四肢造成广泛而严重的损害。及时有效地覆盖创面以最大程度地保留存活组织，对于挽救受伤肢体及其最终功能结局至关重要。在本研究中，采用单穿支蒂游离股前外侧皮瓣，以最大程度地挽救组织，并减少高压电损伤所致四肢的晚期骨骼及神经肌肉并发症。
2012年6月至2015年12月，招募了12例四肢高压电损伤患者。在一期或二期清创后，采用单穿支蒂游离股前外侧皮瓣进行肢体挽救。提取并分析患者的临床记录，包括病因、性别、年龄、穿支类型、缺损部位、入院前病程、缺损及皮瓣大小、重建时机和并发症等。
所有患者均获随访，随访时间为10至25个月，平均随访时间为15.9个月。连续12例高压电损伤患者接受了单穿支蒂游离股前外侧皮瓣手术。皮瓣移植前的平均时间为5.25天，范围为2至8天。清创后创面的平均大小为187.0平方厘米（84 - 350平方厘米），皮瓣的平均大小为265.3平方厘米（119 - 448平方厘米），手术平均时间为314.6分钟（260 - 355分钟）。所有皮瓣均顺利愈合，无相关并发症。所有病例均未观察到供区大腿无力。
单穿支蒂游离股前外侧皮瓣是治疗四肢严重高压电损伤的一种有效且可靠的治疗方法。
