头部深度高压电烧伤创面的修复  

Repair of deep wound on the head due to high-voltage electrical burn

作　　者：许喜生[1] 陈凯[1] 李柏同[1] 周海洋[1] 马铮铮[1] 周永生[1] 欧才生[1] 程勇[1] 黄云[1] 胡永才[1] 张义[1] 王永飞[1] 

机构地区：[1]湖南省郴州市第一人民医院烧伤整形科,423000

出　　处：《中华烧伤杂志》2012年第6期415-418,共4页Chinese Journal of Burns

基　　金：湘南学院自然科学联合基金重点项目（2011YZ09）

摘　　要：目的探讨头部深度高压电烧伤创面的修复方法。方法2002年6月～2012年5月，笔者单位共收治头部深度高压电烧伤患者26例，均为高压电（电压380V～300kV）接触导致头部及全身多处深度电烧伤，烧伤总面积为1％～75％TBSA，深度为深Ⅱ～Ⅳ度。头皮缺损面积为3cm×2cm～20cm×18cm，颅骨外露最大面积为12cm×9cm，颅骨缺损最大面积为7cm×6cm。应用局部推进皮瓣、双侧旋转皮瓣、局部旋转皮瓣结合供瓣区薄中厚皮片移植、吻合血管的游离股前外侧皮瓣、创面愈合前早期扩张器治疗、创面愈合后期扩张器治疗以及薄中厚皮片移植修复创面。结果术后各种皮瓣及薄中厚皮片均成活良好，其中1例有深Ⅱ度创面存在的局部旋转皮瓣并发伤口感染，予以换药缝合后愈合。置入的扩张器扩张顺利。术后随访15d-3年，15例患者完整修复，预后效果良好。结论头部深度高压电烧伤的修复，应根据损伤面积及病情，选用合适的皮瓣结合供瓣区植皮、扩张器置入等方式治疗。Objective To explore the methods for repairing deep wound on the head due to high- voltage electrical burn （HEB）. Methods Twenty-six patients with deep wounds on the head due to HEB were hospitalized from June 2002 to May 2012. They were all injured by higb-vohage （voltage ranged from 380 V to 300 kV） electric current, involving head and several other parts over the body. The total burn area ranged from 1% to 75% TBSA, and the depth ranged from deep partial-thickness to full-thickness （inclu- diug muscle or even bone）. Scalp defect area ranged from 3 cm×2 cm to 20 cm×18 cm, and the maximum size of skull exposure was 12 cm×9 cm and the maximum size of skull defect was 7 cm ×6 cm. The wounds of 26 patients were repaired with 7 local advance flaps, 4 bilateral rotation flaps, 18 local rotation flaps com- bined with thin split-thickness skin grafts in donor site, and 3 free anterolateral thigh flaps with vascular an- astomosis. In four of the 26 patients, expander was used in the early stage after burn and 5 after wound heal- ing （with thin split-thickness grafts ）. Results All flaps and skin grafts survived, except for one flap which was complicated by wound infection, and it was healed after dressing and secondary suturing. The im- planted expander expanded smoothly. Patients were followed up for 15 days to three years after surgery. Sat- isfactory results were obtained, and wounds of 15 patients were repaired completely. Conclusions Deep wound on the head due to HEB should be repaired with suitable flap combined with skin graft in donor site, and implantation of expander according to the injury area and condition of patient.

关 键 词：烧伤 电 头部 外科皮瓣 

分 类 号：R644[医药卫生—外科学]