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Volume 40 Issue 8
Aug.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(8): 732-739
Zhong A,Yun J,Li CY,et al.Treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominal wall[J].Chin J Burns Wounds,2024,40(8):732-739.DOI: 10.3760/cma.j.cn501225-20240429-00157.
Citation: Zhong A,Yun J,Li CY,et al.Treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominal wall[J].Chin J Burns Wounds,2024,40(8):732-739.DOI: 10.3760/cma.j.cn501225-20240429-00157.
shu

Treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominal wall

doi: 10.3760/cma.j.cn501225-20240429-00157

  • Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu 610041, China

Funds:

Science and Technology Project of West China Hospital of Sichuan University HX-1-12302057

More Information
  • Corresponding author: Chen Junjie, Email: cjjemail@163.com
  • Received Date: 2024-04-29
    Abstract
  •   Objective  To explore the treatment methods and clinical efficacy of penetrating high-voltage electric burns to thoracoabdominal wall.  Methods  This study was a retrospective observational study. From March 2020 to March 2023, six male patients with penetrating high-voltage electric burns to thoracoabdominal wall who met the inclusion criteria were hospitalized at West China Hospital of Sichuan University, aged 42 to 57 years. Among them, one patient had thoracoabdominal wall defects with perforation and necrosis of the gastric wall and diaphragm, two patients had thoracoabdominal wall defects with perforation and necrosis of the gastric wall alone, and three patients had abdominal wall defects with perforation and necrosis of the small intestine. In the emergency department, aesthetic plastic and burn surgery, general surgery, and/or thoracic surgery doctors jointly formulated an emergency surgery plan for the patients. Three patients with perforation and necrosis of the gastric wall underwent subtotal gastrectomy and anastomosis. One of them, who also had diaphragmatic perforation and necrosis, underwent resection of the necrotic diaphragm and repair. The other three patients with perforation and necrosis of the small intestine underwent resection and anastomosis of the necrotic intestinal segment. After debriding the thoracoabdominal wall wounds conservatively in stage Ⅰ and repairing the abdominal wall defects with greater omentum coverage, the thoracoabdominal wall wounds were treated with vacuum sealing drainage (VSD). Seven days later, a stage Ⅱ thorough debridement of the thoracoabdominal wall wounds was performed, and bovine acellular dermal matrix was transplanted onto the surface of the greater omentum and the surrounding skin wounds without skin coverage, and the VSD treatment of the thoracoabdominal wall wounds was continued. After 7 days, the VSD treatment was stopped, and after the fresh granulation tissue well developed in the wounds, a stage Ⅲ transplantation of meshed split-thickness skin graft from the lateral femur was performed to close the thoracoabdominal wall wounds, followed by continuing VSD treatment for another 7 days. Data were recorded including the status of patients' enteral nutrition recovery and occurrence of complications such as abdominal infection after stage Ⅰ surgery, the time from starting moist dressing change to the wound being ready for skin grafting after stage Ⅱ surgery, the microbiological culture of wound exudate samples and conditions of wound surrounding areas from starting moist dressing change to wound healing after stage Ⅱ surgery, skin graft survival, and wound healing time. Follow-up was carried out to observe the occurrence of gastrointestinal symptoms, abdominal wall hernia, scars, and functional disorders, etc.  Results  All six patients resumed enteral nutrition on day 2 to 4 after stage Ⅰ surgery, with no occurrence of intestinal obstruction, anastomotic leakage, or abdominal infection. The time from starting moist dressing change to the wound being ready for skin grafting after stage Ⅱ surgery was 8 (6, 12) days. During the period from starting moist dressing change to wound healing after stage Ⅱ surgery, microbiological culture of wound exudate sample showed Enterobacter cloacae in one patient and Pseudomonas aeruginosa in another patient, while the remaining four patients had negative cultures; no patient developed wound edge inflammation. All grafted skin survived, and the wound healing time was 38 (30, 46) days. During follow-up from 12 to 36 months after stage Ⅲ surgery, patients had no intractable constipation or intestinal obstruction symptoms, no obvious local tissue herniation requiring surgical treatment, no scar ulceration, and no functional disorders.  Conclusions  For penetrating high-voltage electric burns to thoracoabdominal wall, a sequential three-stage surgical treatment plan under a multidisciplinary team collaboration model can effectively protect organ function and control wound infection. Long-term follow-up shows good gastrointestinal function and thoracoabdominal wall appearance. This method is highly reproducible and effective, which is suitable for clinical promotion and use.

     

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    • References(35)
  • [1]
    SchweizerR,PedrazziN,KleinHJ,et al.Risk factors for mortality and prolonged hospitalization in electric burn injuries[J].J Burn Care Res,2021,42(3):505-512.DOI: 10.1093/jbcr/iraa192.
    [2]
    KhorD,AlQasasT,GaletC,et al.Electrical injuries and outcomes: a retrospective review[J].Burns,2023,49(7):1739-1744.DOI: 10.1016/j.burns.2023.03.015.
    [3]
    沈余明.进一步重视多部位毁损性高压电烧伤的治疗[J/CD].中华损伤与修复杂志(电子版),2024,19(2):93-98.DOI: 10.3877/cma.j.issn.1673-9450.2024.02.001.
    [4]
    RamlyEP,MacFieR,EshraghiN,et al.Bowel necrosis and 3 limb amputation from high-voltage electrical injury[J].J Burn Care Res,2018,39(4):628-633.DOI: 10.1097/BCR.0000000000000612.
    [5]
    SalehiSH,Sadat AzadY,BagheriT,et al.Epidemiology of occupational electrical injuries[J].J Burn Care Res,2022,43(2):399-402.DOI: 10.1093/jbcr/irab171.
    [6]
    GandhiG,ParasharA,SharmaRK.Epidemiology of electrical burns and its impact on quality of life - the developing world scenario[J].World J Crit Care Med,2022,11(1):58-69.DOI: 10.5492/wjccm.v11.i1.58.
    [7]
    张丕红,黄晓元,黄跃生.深度电烧伤创面早期修复专家共识(2020版)[J].中华创伤杂志,2020,36(10):865-871.DOI: 10.3760/cma.j.cn501098-20200706-00488.
    [8]
    KhataniarH,ShashankS,RajanS,et al.High-voltage electrocution leading to sealed transection of small bowel[J].J Burn Care Res,2020,41(6):1304-1305.DOI: 10.1093/jbcr/iraa124.
    [9]
    XiaoSC,ZhuSH,LiHY,et al.Repair of complex abdominal wall defects from high-voltage electric injury with two layers of acellular dermal matrix: a case report[J].J Burn Care Res,2009,30(2):352-354.DOI: 10.1097/BCR.0b013e318198a6fa.
    [10]
    WuY,LuoJ,LuoY,et al.Severe high-voltage electrical injury: a rare case report[J].J Burn Care Res,2024,45(2):512-519.DOI: 10.1093/jbcr/irad200.
    [11]
    高盛峰,龚振华,蒋亚苏,等.Meek植皮术联合纳米银敷料治疗大面积烧伤患者的效果[J].中外医学研究,2024,22(9):60-63.DOI: 10.14033/j.cnki.cfmr.2024.09.015.
    [12]
    陆晓蔚,胡亮,肖贵喜,等.自体真皮移植联合负压封闭引流修复胫骨前区骨外露创面的临床研究[J/CD].中华损伤与修复杂志(电子版),2022,17(1):54-59.DOI: 10.3877/cma.j.issn.1673-9450.2022.01.009.
    [13]
    杨焕纳,梁琰,韩大伟,等.人工真皮联合自体皮修复儿童手指电烧伤后骨骼和/或肌腱外露创面的效果[J].中华烧伤与创面修复杂志,2023,39(12):1180-1184.DOI: 10.3760/cma.j.cn501225-20231101-00168.
    [14]
    NischwitzSP,LuzeH,KotzbeckP,et al.Electrical burns and their consequences[J].Burns,2020,46(4):982-984.DOI: 10.1016/j.burns.2020.04.015.
    [15]
    梁艳,石文,邵阳,等.早期清创保守去痂后外覆脱细胞真皮基质治疗小儿深度烧伤的效果[J].中华烧伤与创面修复杂志,2024,40(4):348-357.DOI: 10.3760/cma.j.cn501225-20230720-00010.
    [16]
    吴德金,赵遵江,张保德,等.封闭负压引流联合脱细胞真皮和自体刃厚皮移植治疗足踝部创面30例[J].感染、炎症、修复,2022,23(3):145-147,封3.DOI: 10.3969/j.issn.1672-8521.2022.03.004.
    [17]
    马显杰,董琛.瘢痕整复的思考与展望[J].中华烧伤与创面修复杂志,2023,39(9):801-805.DOI: 10.3760/cma.j.cn501225-20230504-00153.
    [18]
    XiaoH,LiuR,LiuX,et al.Reconstruction of severe neck scar contracture after electrical injury[J].J Craniofac Surg,2022,33(1):203-205.DOI: 10.1097/SCS.0000000000007852.
    [19]
    张伟,张卫东,陈斓,等.扩张皮瓣整复大面积烧伤后面颈部瘢痕挛缩畸形的临床效果[J].中华烧伤与创面修复杂志,2023,39(9):826-834.DOI: 10.3760/cma.j.cn501225-20230706-00248.
    [20]
    DurgunM,AksamE.Choosing the right rectangular expander and maximising the benefits from expanded tissue[J].J Wound Care,2019,28(6):416-422.DOI: 10.12968/jowc.2019.28.6.416.
    [21]
    KarimiH,LatifiNA,MomeniM,et al.Tissue expanders; review of indications, results and outcome during 15 years' experience[J].Burns,2019,45(4):990-1004.DOI: 10.1016/j.burns.2018.11.017.
    [22]
    KalraGS,KalraS,GuptaS.Resurfacing in facial burn sequelae using parascapular free flap: a long-term experience[J].J Burn Care Res,2022,43(4):808-813.DOI: 10.1093/jbcr/irab204.
    [23]
    ShiH,WangR,DongW,et al.Synthetic versus biological mesh in ventral hernia repair and abdominal wall reconstruction: a systematic review and recommendations from evidence-based medicine[J].World J Surg,2023,47(10):2416-2424.DOI: 10.1007/s00268-023-07067-5.
    [24]
    LiuZ,WeiN,TangR.Functionalized strategies and mechanisms of the emerging mesh for abdominal wall repair and regeneration[J].ACS Biomater Sci Eng,2021,7(6):2064-2082.DOI: 10.1021/acsbiomaterials.1c00118.
    [25]
    井刚,潘云川,王君.异种脱细胞真皮结合封闭负压引流技术临时重建巨大Ⅲ型腹壁缺损[J].组织工程与重建外科杂志,2020,16(1):43-45.DOI: 10.3969/j.issn.1673-0364.2020.01.010.
    [26]
    ShahmanyanD,JoyMT,CollierBR,et al.A case of burn evisceration with full-thickness injury to abdominal wall, bowel, bladder, and three extremities[J].Surg Case Rep,2021,7(1):220.DOI: 10.1186/s40792-021-01302-8.
    [27]
    DibbsR,TrostJ,DeGregorioV,et al.Free tissue breast reconstruction[J].Semin Plast Surg,2019,33(1):59-66.DOI: 10.1055/s-0039-1677703.
    [28]
    IzadpanahA,MoranSL.Pediatric microsurgery: a global overview[J].Clin Plast Surg,2020,47(4):561-572.DOI: 10.1016/j.cps.2020.06.008.
    [29]
    KimJH,YoonT,ParkJK,et al.Reconstruction of foot and ankle defects using free lateral arm flap: a retrospective review of its versatile application[J].Biomed Res Int,2021,2021:4128827.DOI: 10.1155/2021/4128827.
    [30]
    ZhangPH,LiuZ,RenLC,et al.Early laparotomy and timely reconstruction for patients with abdominal electrical injury: five case reports and literature review[J].Medicine (Baltimore),2017,96(29):e7437.DOI: 10.1097/MD.0000000000007437.
    [31]
    StevensMN,FreemanMH,ShinnJR,et al.Preoperative predictors of free flap failure[J].Otolaryngol Head Neck Surg,2023,168(2):180-187.DOI: 10.1177/01945998221091908.
    [32]
    HagigaA,AdeboyeT,DheansaB.The impact of pre-existing venous pathology on lower limb free flap reconstruction and the role of preoperative screening: a systematic review[J].Acta Radiol,2023,64(7):2302-2312.DOI: 10.1177/02841851221145661.
    [33]
    HandayaAY,SeswandhanaMR,VityadewiN,et al.Multiple ileal perforations as late complications of electrical injury: a rare case report[J].Trauma Case Rep,2024,51:101006.DOI: 10.1016/j.tcr.2024.101006.
    [34]
    BouzatP,ValdenaireG,GaussT,et al.Early management of severe abdominal trauma[J].Anaesth Crit Care Pain Med,2020,39(2):269-277.DOI: 10.1016/j.accpm.2019.12.001.
    [35]
    DursoAM,PaesFM,CabanK,et al.Evaluation of penetrating abdominal and pelvic trauma[J].Eur J Radiol,2020,130:109187.DOI: 10.1016/j.ejrad.2020.109187.
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