Clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist

Du Weili; Shen Yuming; Hu Xiaohua; Qin Fengjun; Cheng Lin

doi:10.3760/cma.j.cn501225-20220719-00296

Volume 39 Issue 6

Jun. 2023

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(6): 527-533

Zhu Zhe, Sun Yu, Zhou Hao, et al. Advances in the research of clinical treatment of hyperpigmentation and hypopigmentation after burns[J]. Chin j Burns, 2020, 36(7): 615-619. Doi: 10.3760/cma.j.cn501120-20190514-00241

Citation:

Du WL,Shen YM,Hu XH,et al.Clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist[J].Chin J Burns Wounds,2023,39(6):527-533.DOI: 10.3760/cma.j.cn501225-20220719-00296.

Citation:

PDF( 11792 KB)

Clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist

doi: 10.3760/cma.j.cn501225-20220719-00296

Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China

Funds:

National Key Research and Development Program of China 2018YFA0703104

Capital Health Development Research Project 2020-2-1123

Discipline Backbone of Beijing Jishuitan Hospital XKGG202209

More Information

Corresponding author: Shen Yuming, Email: shenyuming1963@163.com
Received Date: 2022-07-19

Abstract

Abstract

Objective To investigate the clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist. Methods A retrospective observational study method was used. From September 2016 to October 2021, thirteen male patients (aged 20-43 years) with annular high voltage (10-100 kV) electrical burns on the wrist were admitted to the Beijing Jishuitan Hospital. At the early stage after injury, the patient's wrist was subjected to incision, tension reduction and debridement, with the wound area after debridement being 27 cm×16 cm-32 cm×19 cm; in 12 patients with vascular injury, the radial or ulnar artery was reconstructed by great saphenous vein transplantation, with the length of 15-25 cm; the wrist wound was repaired by free transplantation of the deep inferior epigastric artery paraumbilical perforator flap (if the wound was giant, the lower abdominal flap carrying other perforators was used), with the area of 30 cm×19 cm-35 cm×20 cm. The donor site was repaired by direct suture+skin grafting or relay flap transplantation. After surgery, the survival of flap in recipient area, as well as survival of the skin or flap in donor site were observed. During follow-up, the appearances of the flap in recipient area and the recovery of hand function, as well as the healing of donor site, occurrence of abdominal wall hernia, and scar in skin graft area were observed. Results After surgery, all the 13 patients' paraumbilical perforator flaps survived. Among them, 3 patients had subcutaneous fat necrosis at the distal end of the wrist flap, and the wound had mild infection, which healed after re-expansion and dressing change. All the skin grafts in the donor site of 10 patients survived, and the flaps in the donor site of 3 patients survived well. The patients were followed up for 6 months to 3 years. The flaps in recipient area were in good shape, 8 cases had partial recovery of hand function, and 5 cases had loss of finger flexion function; the donor site of abdominal flap healed well with no abdominal hernia occurred, and the skin graft site had no obvious scar hyperplasia and was soft in texture. Conclusions Early vascular reconstruction after injury, together with free transplantation of the giant deep inferior epigastric artery paraumbilical perforator flap are effective in repairing circular high-voltage electrical burn wounds on the wrist.
- Burns, electric,
- Perforator flap,
- Microsurgery,
- Circumferential wound,
- Vascular reconstruction,
- Wound repair

FullText(HTML)

References(31)

References

[1]	沈余明, 马春旭, 覃凤均, 等. 腕部高压电烧伤创面修复与功能重建[J].中华烧伤杂志,2017,33(12):738-743.DOI: 10.3760/cma.j.issn.1009-2587.2017.12.004.
[2]	沈余明, 覃凤均, 杜伟力, 等. 濒临截肢四肢高压电烧伤患者的保肢策略[J].中华烧伤杂志,2019,35(11):776-783. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.003.
[3]	HuXH, QinFJ, ChenZ, et al. Combined rectus abdominis muscle/paraumbilical flap and lower abdominal flap for the treatment of type Ⅲ circumferential electrical burns of the wrist[J]. Burns, 2013,39(8):1631-1638. DOI: 10.1016/j.burns.2013.04.014.
[4]	沈余明, 田彭, 宁方刚, 等. 腹部联合轴型皮瓣修复腕部环状高压电烧伤创面[J].中华烧伤杂志,2012,28(6):408-410. DOI: 10.3760/cma.j.issn.1009-2587.2012.06.003.
[5]	OferN, BaumeisterS, MegerleK, et al. Current concepts of microvascular reconstruction for limb salvage in electrical burn injuries[J]. J Plast Reconstr Aesthet Surg, 2007,60(7):724-730. DOI: 10.1016/j.bjps.2006.12.010.
[6]	GencelE, EserC, KesiktasE, et al. A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns[J]. Burns, 2016,42(4):e55-60. DOI: 10.1016/j.burns.2015.10.014.
[7]	唐林, 周鑫, 黄宇, 等. 组合股前外侧穿支皮瓣与不同皮瓣瓦合修复肢体大面积环形缺损[J].中国修复重建外科杂志,2021,35(12):1609-1614. DOI: 10.7507/1002-1892.202108002.
[8]	NgZY, TanSS, LellouchAG, et al. Soft tissue reconstruction of complete circumferential defects of the upper extremity[J]. Arch Plast Surg, 2017,44(2):117-123. DOI: 10.5999/aps.2017.44.2.117.
[9]	CiudadP, HuangTC, ManriqueOJ, et al. Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects[J]. Microsurgery, 2019,39(4):316-325. DOI: 10.1002/micr.30413.
[10]	OuQ, WuP, ZhouZ, et al. Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation[J]. Injury, 2021,52(6):1356-1362. DOI: 10.1016/j.injury.2020.10.031.
[11]	OuQ, WuP, PanD, et al. Combined transfer by several perforator skin flaps to cover an extensive and multiplanar wound on the foot and ankle[J]. J Plast Reconstr Aesthet Surg, 2022,75(10):3751-3760. DOI: 10.1016/j.bjps.2022.06.081.
[12]	QingL, LiX, WuP, et al. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps[J]. J Plast Reconstr Aesthet Surg, 2019,72(12):1909-1916. DOI: 10.1016/j.bjps.2019.08.004.
[13]	周鑫, 宋达疆, 邹永根. 游离胸背动脉穿支皮瓣联合旋髂浅动脉穿支皮瓣移植修复下肢大面积环周软组织缺损一例[J].中国修复重建外科杂志,2021,35(3):399-400. DOI: 10.7507/1002-1892.202010007.
[14]	周征兵, 唐举玉, 吴攀峰, 等. 双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损[J].中华显微外科杂志,2020,43(6):535-539. DOI: 10.3760/cma.j.cn441206-20200314-00150.
[15]	刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损[J].中国修复重建外科杂志,2021,35(7):886-890. DOI: 10.7507/1002-1892.202103023.
[16]	沈余明, 胡骁骅, 宓惠茹, 等. 四肢高压电烧伤创面的早期处理[J].中华烧伤杂志,2011,27(3):173-177. DOI: 10.3760/cma.j.issn.1009-2587.2011.03.003.
[17]	沈余明, 陈旭, 张琮, 等. 旋股外侧动脉降支血流桥接皮瓣修复患者腕部高压电烧伤创面的效果[J].中华烧伤杂志,2017,33(7):422-425. DOI: 10.3760/cma.j.issn.1009-2587.2017.07.006.
[18]	WangC, ShenYM, QinFJ, et al. Free flow-through anterolateral thigh flaps for wrist high-tension electrical burns: a retrospective case series[J]. Biomed Environ Sci, 2020,33(7):510-517. DOI: 10.3967/bes2020.064.
[19]	李利根, 柴家科. 肢体高压电烧伤软组织及血管损伤的影像学判断及临床意义[J].中华烧伤杂志,2020,36(11):1009-1012. DOI: 10.3760/cma.j.cn501120-20190904-00371.
[20]	黎淑娟, 王正磊, 朱维平, 等. 四肢高压电烧伤早期磁共振成像特点的临床研究[J].中华烧伤杂志,2017,33(12):750-756. DOI: 10.3760/cma.j.issn.1009-2587.2017.12.006.
[21]	NettelbladH, ThuomasKA, SjöbergF. Magnetic resonance imaging: a new diagnostic aid in the care of high-voltage electrical burns[J]. Burns, 1996,22(2):117-119. DOI: 10.1016/0305-4179(95)00104-2.
[22]	刘灿丽, 孙勇, 顾亚律, 等. 多层螺旋CT高压电损伤肢体灌注成像临床应用[J].中国临床医学影像杂志,2012,23(2):100-102. DOI: 10.3969/j.issn.1008-1062.2012.02.008.
[23]	徐勇辉, 孙勇, 刘灿丽, 等. 256层螺旋CT灌注成像对高压电击伤截肢适应证判断的初步应用[J].影像诊断与介入放射学,2015,24(1):59-63. DOI: 10.3969/j.issn.1005-8001.2015.01.011.
[24]	吴有森, 鲍海华, 孙艳秋, 等. CT血管成像在四肢高压电击伤中的应用[J].实用放射学杂志,2012,28(10):1595-1598. DOI: 10.3969/j.issn.1002-1671.2012.10.028.
[25]	杨智斌, 牛建栋, 马勇, 等. CT血管造影及三维重建在组织瓣修复颈肩、腋窝及上臂高压电烧伤创面中的临床应用[J].中华烧伤杂志,2018,34(12):874-880. DOI: 10.3760/cma.j.issn.1009-2587.2018.12.011.
[26]	沈余明. 高压电烧伤创面修复与功能重建[J].中华烧伤杂志,2018,34(5):257-262. DOI: 10.3760/cma.j.issn.1009-2587.2018.05.001.
[27]	文一臻, 张丕红, 任利成, 等. 136例上肢电烧伤患者的临床特征及修复效果[J].中华烧伤杂志,2019,35(11):784-789. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.004.
[28]	AyazM. High voltage electrical injury, early vs. late wound excision, and coverage[J]. Burns, 2020,46(6):1476-1477. DOI: 10.1016/j.burns.2020.04.043.
[29]	DeBonoR. A histological analysis of a high voltage electric current injury to an upper limb[J]. Burns, 1999,25(6):541-547. DOI: 10.1016/s0305-4179(99)00029-7.
[30]	KalkanT, DemirM, AhmedAS, et al. A dynamic study of the thermal components in electrical injury mechanism for better understanding and management of electric trauma: an animal model[J]. Burns, 2004,30(4):334-340. DOI: 10.1016/j.burns.2003.11.009.
[31]	ZeltRG, DanielRK, BallardPA, et al. High-voltage electrical injury: chronic wound evolution[J]. Plast Reconstr Surg, 1988, 82(6): 1027-1041. DOI: 10.1097/00006534-198812000-00014.

Relative Articles

[1]	Liu Yangyang, Wu Min, Zhu Jun, Zhang Kuankuan, Niu Haizhou, Gao Xubin, Han Zhongbing, Liu Fendou. Clinical effects of free superficial circumflex iliac artery superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(1): 72-77. doi: 10.3760/cma.j.cn501225-20230727-00018
[2]	Zhou Feiya, Zhang Xian, Cai Leyi, Chen Mingming, Tao Zhenyu, Zhu Xuwei, Gao Weiyang. Effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(2): 165-171. doi: 10.3760/cma.j.cn501225-20231030-00150
[3]	Chen Yan, Xie Bin, Liu Yuanjun, Wu Jian. Effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(10): 971-977. doi: 10.3760/cma.j.cn501225-20231202-00224
[4]	Zheng Yun, Cheng Liangkun, Cui Liuchao, Tan Yuzhong, Tian Lin. Clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(5): 476-481. doi: 10.3760/cma.j.cn501225-20231130-00221
[5]	Liu Fei, Yan Weiqi, Ma Qiang, Liu Yibin, Yang Zhibin. Clinical effect of anterolateral thigh flow-through chimeric perforator free flap transplantation in the treatment of upper limb complex tissue defects with main artery injury[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(2): 172-179. doi: 10.3760/cma.j.cn501225-20231103-00176
[6]	Zhou Shuping, Li Shimin, Shi Yingguang, Zheng Liwu, Chang Chaonan, Chen Junjie, Wang Huanpeng, Sun Ke, Wang Xiuhuan, Liu Linbo. Clinical effects of parallel combined flow-through perforator flaps in the treatment of circular hot crush injuries in limbs with blood supply disorder[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(7): 665-672. doi: 10.3760/cma.j.cn501225-20231201-00222
[7]	Zhang Pihong. A brief discussion on the harvest of thinned perforator flap, detection of perforator vessels, and evaluation of flap blood supply[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(10): 911-918. doi: 10.3760/cma.j.cn501225-20230812-00047
[8]	Xia Chengde, Di Haiping, Xing Peipeng, Huang Wanxin, Xue Jidong, Cao Dayong, Guo Haina, Liu Lei, Li Pengcheng. Effects of free gracilis muscle flap combined with sural nerve transfer for reconstruction of digital flexion and sensory function of hand in patient with wrist electric burn[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(3): 228-233. doi: 10.3760/cma.j.cn501225-20221203-00525
[9]	Ji Peng, Cao Tao, Zhang Zhi, Zheng Zhao, Liang Min, Tian Chenyang, Hao Tong, Chen Leilei, Hu Dahai, Han Juntao, Tao Ke. Effects of the anterolateral thigh chimeric perforator flaps in repairing complex wounds of foot and ankle[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(10): 926-932. doi: 10.3760/cma.j.cn501225-20230627-00232
[10]	Cheng Heyun, Ju Jihui, Zhao Qiang, Liu Shengzhe, Zhang Guangliang, Zhang Tao, Wang Benyuan, Guo Quanwei, Liu Shuang. Effects of free superficial peroneal artery perforator flap in repairing small and medium-sized thermal crush injury wounds in the hand[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(6): 546-551. doi: 10.3760/cma.j.cn501225-20220623-00256
[11]	Han Fu, Yang Xuekang, He Ting, Wang Luxu, Zhang Nan, Han Juntao. Curative effects of medial plantar free flap in reconstructing electric burn wound and scar contracture in the palm[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(9): 820-825. doi: 10.3760/cma.j.cn501225-20230601-00197
[12]	Li Hai, Xiao Shun'e, Deng Chengliang, Wu Bihua, Wu Xiangkui, Zhang Tianhua, Liu Zhiyuan, Wei Zairong. Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(8): 758-764. doi: 10.3760/cma.j.cn501225-20220720-00300
[13]	Wang Hui, Zhou Tong, Liu Yujie, Zhang Yihan, Liu Ying, Ma Tiepeng, Yang Xiaoxi. Effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(11): 1038-1046. doi: 10.3760/cma.j.cn501225-20230720-00009
[14]	Yang Chengpeng, Tang Linfeng, Liu Zhijin, Liu Shengzhe, Yang Lin, Cheng Junnan, Zhang Tao, Sun Fengwen, Huang Yongtao, Gao Qinfeng, Ju Jihui. Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(9): 842-848. doi: 10.3760/cma.j.cn501225-20220726-00310
[15]	Zhang Tao, Cheng Junnan, Yang Lin, Huang Yongtao, Gao Qinfeng, Sun Fengwen, Liu Zhijin, Liu Shengzhe, Yang Chengpeng, Cao Yang, Ju Jihui. Curative effects of the superficial peroneal artery perforator flap carrying multiple perforators in repairing hand and foot wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(3): 234-240. doi: 10.3760/cma.j.cn501225-20220723-00305
[16]	Zhang Tao, Cheng Junnan, Yang Lin, Sun Fengwen, Gao Qinfeng, Huang Yongtao, Yang Chengpeng, Cao Yang, Liu Zhijin, Ju Jihui. Effects of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(7): 655-661. doi: 10.3760/cma.j.cn501225-20220930-00428
[17]	Xue Jidong, Di Haiping, Liang Yan, Xing Peipeng, Guo Haina, Zhao Xiaokai, Wang Limin, Xia Chengde. Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(8): 724-730. doi: 10.3760/cma.j.cn501225-20230323-00094
[18]	Liu Yunhan, Huang Xin, Li Haizhou, Gao Yashan, Gu Shuchen, Yimin Khoong, Luo Shenying, Zhang Zewei, Gu Bin, Zan Tao. Clinical application of expanded internal mammary artery perforator flap combined with vascular supercharge in reconstruction of faciocervical scar[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(4): 313-320. doi: 10.3760/cma.j.cn501120-20210928-00334
[19]	Yang Lin, Liu Zhijin, Cheng Junnan, Gao Qinfeng, Yang Chengpeng, Liu Shengzhe, Zhang Tao, Sun Fengwen, Huang Yongtao, Ju Jihui. Anatomical characteristics and clinical application of anterolateral thigh perforator flap pedicled with oblique branch trunk of lateral circumflex femoral artery in the muscular septum[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(12): 1133-1139. doi: 10.3760/cma.j.cn501225-20220227-00039

Supplements(0)

Cited By

Cited by

Periodical cited type(8)

1.	邝江波，王永飞，谭成波，许喜生. 改良自体中厚皮片在修复功能部位深度烧伤创面中的应用. 中国美容医学. 2023(02): 39-42 .
2.	陈涛，高绍莹. 负压封闭引流在烧伤创面中的应用研究进展. 中国烧伤创疡杂志. 2023(02): 111-114 .
3.	彭敏，常东方，姚智华，孔超，李朝芬，唐治琴，唐津渝. 小柱皮散布式种植治疗肉芽创面临床观察. 重庆医学. 2022(22): 3840-3846 .
4.	于洋，杨媛媛，吴月婷，赵行，井温馨. 微聚焦超声在面部软组织松弛中的临床应用. 中国医疗美容. 2021(09): 73-75 .
5.	佟琳，胡晓龙，张万福，韩飞，计鹏，胡大海，官浩. 腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果. 中华烧伤杂志. 2021(11): 1048-1053 .
6.	马艳，刘萍，郭爱玲. 预真空脐部加压包扎在单孔腹腔镜手术治疗异位妊娠患者切口处理中的应用. 中华解剖与临床杂志. 2021(06): 712-715 .
7.	谢丰松，吕朝阳，陈传亮，邓磊，黄成，姜凡. 持续负压伤口疗法与常规打包加压包扎在难固定部位创面中厚皮移植术中的应用比较. 中国医师杂志. 2021(11): 1686-1689 .
8.	杨敏烈，周小金，朱宇刚，姜东林，丁羚涛，储国平，赵朋，程佳，吕国忠，李青峰. 不同模式持续负压伤口疗法对下肢静脉性溃疡创面的临床疗效及其影响因素前瞻性随机对照研究. 中华烧伤杂志. 2020(12): 1149-1158 .

Other cited types(0)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(3)

Get Citation

PDF

XML

Article Metrics

Article views (1139) PDF downloads(87)

Clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist

doi: 10.3760/cma.j.cn501225-20220719-00296