Clinical characteristics and repair effect of 136 patients with electric burns of upper limb
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摘要:
目的 分析上肢电烧伤患者的临床特征及其创面修复方法和效果。 方法 回顾性分析2015年1月—2019年3月笔者单位收治的符合入选标准的136例上肢电烧伤患者的病历资料。统计上肢电烧伤患者占同期电烧伤患者的比例、性别、年龄、入院时间、人群类别、致伤原因、致伤电压，上肢烧伤面积、深度，双上肢同时受伤情况及其早期创面处理措施。分类统计每个患肢的主要修复方法。记录患者总体疗效，包括术后创面并发症、愈合情况等。对行远位带蒂皮瓣、游离皮瓣移植修复的患者随访3～6个月，统计皮瓣成活率，评估患肢术后功能，采用疗效评分表对其满意度进行调查。比较高压电与低压电致伤患者的截肢率、年龄与上肢烧伤面积。对数据行Wilcoxon秩和检验、
χ 2检验或Fisher确切概率法检验。 结果 (1)上肢电烧伤患者占同期收治的154例电烧伤患者的88.3%，其中男117例、女19例，年龄1岁2个月～72岁[(34±18)]岁，入院时间为伤后1 h～48 d。患者中，电力职业工人51例、农民工32例、学生及学龄前儿童31例、其他类别人员22例，前2类患者以工作不慎受伤为主，后2类患者以触及电源或电源漏电致伤为主。患者中，高压电烧伤75例、低压电烧伤61例；上肢烧伤面积0.2%～16.0%[2%(1%，5%)]体表总面积(TBSA)，其中Ⅲ～Ⅳ度创面面积为0.2%～15.0%[2%(1%，5%)]TBSA；双上肢同时受伤者有54例，占39.7%；73个患肢早期行筋膜切开减张术。(2)13个患肢经换药处理；2个患肢清创后直接缝合；56个患肢移植皮片修复；12个患肢移植局部皮瓣修复，45个患肢移植远位带蒂皮瓣修复，22个患肢移植游离皮瓣修复；40个患肢截肢，占21.1%。(3)除1例患者术后因肺部感染、脓毒症、多器官功能衰竭死亡外，其余患者全部治愈。1例患者移植的腹部皮瓣完全撕脱，换药后移植皮片修复；1例患者移植股前外侧皮瓣后发生坏死，改行腹部皮瓣带蒂移植修复；7例患者移植腹部皮瓣后蒂部或边缘出现少许糜烂，经换药愈合；6例患者移植腹部皮瓣后远端出现局部青紫，经高压氧等保守治疗后愈合；其余皮瓣均存活良好。(4)远位带蒂皮瓣移植成活率为97.8%(44/45)，游离皮瓣移植成活率为95.5%(21/22)，两者相近(
P >0.05)。游离皮瓣移植术后患肢功能恢复情况优于远位带蒂皮瓣移植(
Z ＝－3.054，
P <0.01)，但是两者的患者疗效满意度相近(
Z ＝－0.474，
P >0.05)。(5)高压电烧伤患者的截肢率、年龄、上肢烧伤面积均高于或大于低压电烧伤患者(
χ 2＝4.743,
Z ＝－2.801、－6.469，
P <0.05或
P <0.01)。 结论 上肢电烧伤好发于儿童、电力职业工人及农民工，且截肢率高，老师及家长应加强对儿童的安全教育并管理好生活电源，工人群体应提高安全意识、规范操作；电烧伤创面筋膜切开减张术应尽早进行，且早期扩创后移植皮瓣可有效修复创面，其中游离皮瓣移植术后上肢功能恢复较好。
Abstract:Objective To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns. Methods Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test. Results (1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22,
P >0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (
Z =-3.054,
P <0.01), but their satisfaction degree of patients was similar (
Z =-0.474,
P >0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (
χ 2=4.743,
Z =-2.801, -6.469,
P <0.05 or
P <0.01). Conclusions Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.
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Key words:
- Burns, electric /
- Surgical flaps /
- Wound repair
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