Pessoa Vaz M, Brandão C, Meireles R, Brito I M, Ferreira B, Pinheiro S, Zenha H, Ramos S, Diogo C, Teles L, Cabral L, Lima J
Department of Plastic Surgery and Burns Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
Ann Burns Fire Disasters. 2018 Sep 30;31(3):233-237.
Despite the wide and growing use of microsurgery, its application in primary burn reconstruction is not very frequent as it faces a number of additional challenges in this setting. A retrospective analysis of the clinical records of all patients submitted to microvascular free tissue transfer for primary burn reconstruction over an 8-year period (from January 2009 to December 2016) was performed. An evaluation of the indications, timing, principles of flap selection, complications and outcomes of free tissue transfer in primary burn reconstruction was made. Fourteen patients required 18 microsurgical flaps for acute soft tissue reconstruction (1.1% of all patients admitted). 64.3% of the patients were male. The mean age was 59.64 years, and mean TBSA was 10.5%. The majority of the injuries were caused by flames (71.4%), followed by electrical contact (21.4%). The primary indication for microsurgical reconstruction was tissue deficit with exposure of tendons, nerves, vessels, bone and/or joints after debridement. The procedure was more often performed in the early period after injury (between the 5th and 22nd day). The most frequently used flaps were the Latissimus dorsi and the anterolateral thigh flap. Major complications included 2 total flap failures (11.1%) and a partial flap failure that required reconstruction with another free flap. Microsurgical free flaps have a valuable role in primary burn reconstruction. Despite the reported higher complication rate in this specific clinical scenario, their use may reduce the total number of surgeries needed to achieve wound closure.
尽管显微外科手术的应用广泛且不断增加，但它在烧伤一期重建中的应用并不十分常见，因为在这种情况下它面临着一些额外的挑战。对8年间（2009年1月至2016年12月）所有接受微血管游离组织移植进行烧伤一期重建的患者的临床记录进行了回顾性分析。对烧伤一期重建中游离组织移植的适应证、时机、皮瓣选择原则、并发症及结果进行了评估。14例患者需要18个显微外科皮瓣进行急性软组织重建（占所有入院患者的1.1%）。64.3%的患者为男性。平均年龄为59.64岁，平均烧伤总面积为10.5%。大多数损伤由火焰引起（71.4%），其次是电接触伤（21.4%）。显微外科重建的主要适应证是清创后出现肌腱、神经、血管、骨骼和/或关节外露的组织缺损。该手术更多在伤后早期（第5天至第22天之间）进行。最常用的皮瓣是背阔肌皮瓣和股前外侧皮瓣。主要并发症包括2例皮瓣完全坏死（11.1%）和1例部分皮瓣坏死，需要用另一个游离皮瓣进行重建。显微外科游离皮瓣在烧伤一期重建中具有重要作用。尽管在这一特定临床场景中报道的并发症发生率较高，但使用它们可能会减少实现伤口闭合所需的手术总数。
