上肢毁损性电烧伤的救治方法及其临床疗效  

Treatment methods of upper limbs with destructive electric burns and its clinical efficacy

作　　者：张伟 陈斓 杨飞 张卫东 刘峰 谢卫国 Zhang Wei;Chen Lan;Yang Fei;Zhang Weidong;Liu Feng;Xie Weiguo(Department of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院烧伤科,武汉430060

出　　处：《中华烧伤与创面修复杂志》2023年第8期731-737,共7页Chinese Journal of Burns And Wounds

基　　金：湖北省卫生健康科研基金(WJ2019H433);武汉市临床医学科研项目(WX17A03、WX11A04);武汉市医学科研项目(WG19B02)。

摘　　要：目的探讨上肢毁损性电烧伤的救治方法及其临床疗效。方法采用回顾性观察性研究方法。2014年7月—2020年12月,武汉大学同仁医院暨武汉市第三医院收治20例符合入选标准的上肢毁损性电烧伤男性患者,其年龄为21~57岁,其中7例患者行急诊手术,共对20个患肢行保肢治疗。对5个患肢坏死骨行切除处理,将1例患者左侧患肢远端残余手及腕部交叉异位再植至右前臂残端,对2个尺桡骨远端坏死患肢行截骨后短缩再植。彻底清创后,拟用组织瓣修复的创面面积为12 cm×7 cm~58 cm×13 cm。根据创面大小和分布,采用带蒂背阔肌肌皮瓣联合吻合血管的游离腹股沟皮瓣移植修复2个患肢创面;游离移植背阔肌肌皮瓣、股前外侧皮瓣、脐旁穿支皮瓣修复其余17个患肢创面,其中创面较大的10个患肢联合移植腹股沟皮瓣或另一侧脐旁穿支皮瓣。移植组织瓣总面积为20 cm×8 cm~52 cm×20 cm。组织瓣移植术中,根据患肢血管缺损长度,分别用组织瓣血管蒂远端、患侧无损伤静脉、腹壁浅静脉、大隐静脉等桥接14个患肢远端动脉,并对其中3个远端回流不畅患肢行大隐静脉移植再通肢体远端静脉。对供瓣区创面行直接缝合或刃厚头皮移植修复。创面基本愈合后开始循序渐进的功能康复训练,组织瓣移植术后3个月开始进行功能重建和瘢痕整复手术。记录术后组织瓣/皮片成活及创面愈合情况、保肢情况和随访情况,末次随访时评估保肢成功患肢的功能并使用臂、肩、手残障(DASH)评分表进行评分。结果术后,患肢移植的组织瓣及供瓣区创面移植的皮片均成活,供受区创面愈合良好。2个患肢于组织瓣移植术后10 d内出现远端坏死,行前臂中上段截肢;其余18个患肢保肢(含短缩再植与交叉异位再植)成功。随访6~48个月,5个保肢成功患肢于组织瓣移植术后3~18个月出现残余肌腱和骨组织无菌性溶解排出,经手�Objective To investigate the treatment methods of upper limbs with destructive electric burns and its clinical efficacy.Methods A retrospective observational study was conducted.From July 2014 to December 2020,20 male patients with destructive electric burns in upper limbs who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital,aged from 21 to 57 years,of whom 7 patients underwent emergency surgery,and a total of 20 affected limbs were treated with limb salvage.The necrotic bone was resected in 5 affected limbs,the residual hand and wrist at the distal end of left affected limb was replanted to the residual end of the right forearm in one patient in a cross heterotopic way,and short reduction and replantation after osteotomy were performed for two affected limbs with distal ulnar and radial necrosis.After thorough debridement,the area of wound proposed to be repaired by tissue flap was from 12 cm×7 cm to 58 cm×13 cm.According to the size and distribution of wound,the wounds of 2 affected limbs were repaired by transplantation of pedicled latissimus dorsi myocutaneous flap and free groin flap with vascular anastomosis.The wounds of the remaining 17 affected limbs were repaired with the transplantation of free latissimus dorsi myocutaneous flap,anterolateral thigh flaps,and paraumbilical perforator flap,with 10 affected limbs with larger wounds being jointly transplanted with the groin flap or the paraumbilical perforator flap on the other side.The total grafted tissue flap area was 20 cm×8 cm to 52 cm×20 cm.During tissue flap transplantation,according to the length of blood vessel defect in the affected limb,the distal artery of the affected limb was bridged with the distal part of flap vascular pedicle,undamaged vein on the affected side,superficial vein of abdominal wall,and great saphenous vein,etc.,in 14 affected limbs,and the great saphenous vein was grafted in 3 of them with impeded distal return for recanalization of distal limb veins.The wound in the do

关 键 词：烧伤 电 外科皮瓣 显微外科手术 截肢术 动静脉吻合 手功能 保肢 

分 类 号：R647[医药卫生—外科学]