Talanker Michael M, Fallah Kasra N, Hartline Cassie A, Freet Daniel J
Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
Eplasty. 2023 Jan 16;23:e3. eCollection 2023.
Electrical injuries from high-voltage power lines are unique forms of trauma that can create challenging wounds for reconstructive surgeons. Our patients, a man in his late thirties (Patient 1) and a man in his early twenties (Patient 2), both sustained upper extremity injuries after contact with a high-voltage line.
Despite minimal superficial damage, both patients required fasciotomies and debridement of the volar forearm, revealing segmental defects in most digital tendons as well as the distal median nerve. Free fasciocutaneous anterolateral thigh (ALT) flaps were harvested to ensure adequate wound coverage. Additionally, fascia lata grafts were taken from the free flap donor site and rolled into tubes to transfer available flexor digitorum superficialis proximal tendon stumps to the distal stumps of flexor digitorum profundus. The rolls were also used to bridge segmental tendon defects in flexor pollicis longus, while cadaveric nerve allografts were used to bridge the median nerve defects.
Nine months postoperatively, Patient 1 had premorbid function with activities of daily living (ADLs), and Patient 2 required only minimal assistance with instrumental ADLs. Within a year following reconstruction, Patient 1 mostly regained range of motion in his digits with some rigidity, and Patient 2 regained full range of motion in his digits with minimal rigidity.
These cases have demonstrated that the use of an ALT free flap combined with rolled fascia lata graft tubes may be an effective choice for reconstruction and functional restoration in cases of severe high-voltage electrical trauma.
高压电线造成的电击伤是一种独特的创伤形式，会给重建外科医生带来具有挑战性的伤口。我们的患者，一位三十多岁的男性（患者1）和一位二十出头的男性（患者2），在接触高压电线后均上肢受伤。
尽管表面损伤轻微，但两名患者均需要进行筋膜切开减压术和掌侧前臂清创术，结果发现大多数指肌腱以及正中神经远端存在节段性缺损。切取游离股前外侧筋膜皮瓣（ALT）以确保伤口得到充分覆盖。此外，从游离皮瓣供区获取阔筋膜移植片并卷成管状，将可用的指浅屈肌近端肌腱残端转移至指深屈肌远端残端。这些卷状移植片还用于桥接拇长屈肌的节段性肌腱缺损，而同种异体尸体神经移植片则用于桥接正中神经缺损。
术后9个月，患者1在日常生活活动（ADL）中恢复了病前功能，患者2在工具性ADL方面仅需要极少的帮助。重建后一年内，患者1的手指大部分恢复了活动范围，但有些僵硬，患者2的手指恢复了完全活动范围，僵硬程度最小。
这些病例表明，对于严重的高压电击伤病例，使用游离ALT皮瓣联合卷状阔筋膜移植管可能是重建和功能恢复的有效选择。
