Clinical efficacy of free medial sural artery perforator flap transplantation in repairing electric burn wounds of hands and feet

Zhang Weidong; Zhang Wei; Yu Gang; Chen Lan; Gong Xiang; Xie Weiguo; Ru Tianfeng

doi:10.3760/cma.j.cn501225-20240611-00226

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Zhang Weidong,Zhang Wei,Yu Gang,et al.Clinical efficacy of free medial sural artery perforator flap transplantation in repairing electric burn wounds of hands and feet[J].Chin J Burns Wounds,2025,41(4):1-9.DOI: 10.3760/cma.j.cn501225-20240611-00226.

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Clinical efficacy of free medial sural artery perforator flap transplantation in repairing electric burn wounds of hands and feet

doi: 10.3760/cma.j.cn501225-20240611-00226

Institute of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan 430060, China

Funds:

The Natural Science Foundation of Hubei Province 2024AFB470

Research Project of Wuhan Municipal Health and Family Planning Commission WX18Q44

Knowledge Innovation Program of Wuhan-Shuguang Project 2022020801020553

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Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com
Received Date: 1999-11-30
Available Online: 2025-04-02

Abstract

Abstract

Objective To explore clinical efficacy of free medial sural artery perforator flap transplantation in repairing electric burn wounds of hands and feet. Methods This study was a retrospective observational study. From November 2017 to September 2023, 21 male patients aged 28-51 years with electric burns on hands and feet who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital. There were 23 wounds, of which 14 were on the hand and 9 on the foot; nine were associated with exposed tendon injury, six were associated with bone exposure or necrosis, and eight were associated with joint injury. The wound area after debridement was 5.0 cm× 3.0 cm-14.0 cm× 10.0 cm. For 2 wide wounds and 2 polydactyly/toe wounds, a lobulated flap centered on 2 medial sural artery perforators was designed and incised for repair. For other wounds, the perforator flap of the medial sural artery was designed and incised, and the flap area was 6.0 cm× 3.5 cm-16.0 cm×11.0 cm. The flap arteriovenous line was anastomosed end-to-end with the arteriovenous line of the recipient area; the cutaneous nerves of 10 flaps were anastomosed with the recipient nerves, and the sural nerve bundle was cut to repair the defect of one digital nerve. The donor site was closed with tension-relieving sutures. Postoperative flap survival and donor site healing were recorded. During follow-up, secondary revisions of the flap were recorded, the texture and appearance of the flap, as well as the scarring and functional recovery of the donor valve area of the lower leg, were observed. At the last follow-up, the recovery of hand flap sensation was observed, the satisfaction of patients with the treatment effect of each operation was investigated by Likert scale, the hand function of patients was evaluated by the trial criteria of upper limb function evaluation of the Chinese Medical Association Hand Surgery, and the weight-bearing walking ability of patients with lower limb wounds was evaluated by Holden walking ability grading. Results There was a slight necrosis at the distal end of one flap after surgery, which healed after dressing change. All 23 flaps survived. The sutures of the two donor areas were poorly healed due to high local tension, and the second sutures were performed after debridement and drainage, and the healing was good. The wounds of the remaining 21 donor valve sites healed well. After 6-26 months of follow-up, 3 flaps were slightly bloated, and the appearance was improved after flap reconstruction; 1 hand wound after interphalangeal joint fusion, with good repair effect; the rest of the flaps were not reconstructed. All the skin flaps were soft and similar to the surrounding tissue morphology. Linear scarring remains in the donor valve area of the lower leg, and walking function is normal. At the last follow-up, the protective sensation of the hand flap was restored; the patients were very satisfied with the results of 21 surgeries and were relatively satisfied with the results of 2 surgeries. 10 of the 14 patients with hand wounds were rated as excellent, 3 were very good, and 1 was acceptable, and Holden walking ability of 7 patients with foot wounds was grade V. Conclusions The medial sural artery perforator flap has the advantages of reliable blood supply, thin and flat flap, can be lobulated or cut according to the shape of the wound, and the shape and function of the recipient area are better restored, and the patients are highly satisfied with the surgical treatment effect, which is one of the surgical methods available for repairing electric burn wounds of hands and feet.
- Burns, electric,
- Microsurgery,
- Medial sural artery perforator flap,
- Wounds on hands and feet,
- Free skin flap,
- Wound repair

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References

[1]	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.
[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]	张丕红. 加强规范化诊治改善电烧伤预后[J].中华烧伤杂志,2019,35(11):772-775. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.002.
[4]	ChenX, ZhangC, ChengL, et al. Survival and versatility of the flow-through lateral-thigh free flap in severe electrical injuries to the wrist[J]. Ann Plast Surg, 2020,85(6):612-617. DOI: 10.1097/SAP.0000000000002355.
[5]	DePamphilisMA, CauleyRP, SadeqF, et al. Reconstruction of the upper extremity high-voltage electrical injury: a pediatric burn hospital's 13-year experience[J]. J Burn Care Res, 2022,43(3):696-703. DOI: 10.1093/jbcr/irab177.
[6]	Al-HimdaniS, DinA, WrightTC, et al. The medial sural artery perforator (MSAP) flap: a versatile flap for lower extremity reconstruction[J]. Injury, 2020,51(4):1077-1085. DOI: 10.1016/j.injury.2020.02.060.
[7]	潘达德, 顾玉东, 侍德,等. 中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135. DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[8]	ShihJG, ShahrokhiS, JeschkeMG. Review of adult electrical burn injury outcomes worldwide: an analysis of low-voltage vs high-voltage electrical injury[J]. J Burn Care Res, 2017,38(1):e293-e298. DOI: 10.1097/BCR.0000000000000373.
[9]	DingH, HuangM, LiD, et al. Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China[J]. J Int Med Res, 2020,48(3):300060519891325. DOI: 10.1177/0300060519891325
[10]	尹凯, 陈辉, 陈欣, 等. 621例电烧伤住院患者的流行病学调查[J].中国医刊,2024,59(3):271-275. DOI: 10.3969/j.issn.1008-1070.2024.03.010.
[11]	张伟, 陈斓, 杨飞, 等. 上肢毁损性电烧伤的救治方法及其临床疗效[J].中华烧伤与创面修复杂志,2023,39(8):731-737. DOI: 10.3760/cma.j.cn501225-20230530-00188.
[12]	ZhuJ, YanL, HuR, et al. Artificial dermis combined with negative pressure wound therapy and platelet-rich plasma to treat traumatic wounds: a retrospective study[J]. J Wound Care, 2024,33(3):189-196. DOI: 10.12968/jowc.2024.33.3.189.
[13]	LvZ, WangQ, JiaR, et al. Pelnac® artificial dermis assisted by VSD for treatment of complex wound with bone/tendon exposed at the foot and ankle, a prospective study[J]. J Invest Surg, 2020,33(7):636-641. DOI: 10.1080/08941939.2018.1536177.
[14]	GuoY, LiuX, ChenL. Treating hand high-voltage electrical burn by combination of radial artery perforator flap, artificial dermis, and vacuum sealing drainage[J]. Plast Reconstr Surg Glob Open, 2023,11(11):e5397. DOI: 10.1097/GOX.0000000000005397.
[15]	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.
[16]	胡大海, 王耘川. 进一步重视特殊原因及部位烧伤创面处理[J].中华烧伤与创面修复杂志,2023,39(3):209-214. DOI: 10.3760/cma.j.cn501225-20230206-00034.
[17]	薛继东, 狄海萍, 梁琰, 等. 足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效[J].中华烧伤与创面修复杂志,2023,39(8):724-730. DOI: 10.3760/cma.j.cn501225-20230323-00094.
[18]	DemmerW, SorgH, SteiertA, et al. Wound healing and therapy in soft tissue defects of the hand and foot from a surgical point of view[J]. Med Sci (Basel), 2021,9(4)DOI: 10.3390/medsci9040071.
[19]	刘峰, 张伟, 谢卫国, 等. 微型游离髂腹股沟穿支皮瓣修复手部小型创面的临床效果[J]. 中华烧伤与创面修复杂志. DOI: 10.3760/cma.j.cn501225-20230701-00244.
[20]	徐军辉, 张伟, 周锦秀, 等. 游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(11):1030-1037. DOI: 10.3760/cma.j.cn501225-20230804-00039.
[21]	NikkhahD, YassinA, KodamaH, et al. Ultrathin anterolateral thigh free flap: an adipocutaneous flap with the most superficial elevation plane[J]. Plast Reconstr Surg, 2024,154(4):844e-846e. DOI: 10.1097/PRS.0000000000011387.
[22]	ZhouJD, ZhangXF, XuTL, et al. Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site[J]. J Orthop Surg (Hong Kong), 2023,31(2):10225536231181706. DOI: 10.1177/10225536231181706.
[23]	万强, 何贤标, 赵云珍, 等. 游离腓肠内侧动脉穿支皮瓣修复远足皮肤缺损的临床效果[J].中华显微外科杂志,2017,40(6):593-595. DOI: 10.3760/cma.j.issn.1001-2036.2017.06.024.
[24]	李甲, 朱辉, 郑大伟, 等. 游离腓肠内侧动脉穿支皮瓣修复前足背侧中小型创面[J].中华显微外科杂志,2017,40(6):544-546. DOI: 10.3760/cma.j.issn.1001-2036.2017.06.007.
[25]	陈步国, 张松, 潘勇, 等. 腓动脉近端穿支皮瓣修复手足部中小型创面的临床治疗效果[J].中华手外科杂志,2023,39(6):565-568. DOI: 10.3760/cma.j.cn311653-20230104-00004.
[26]	LiSJ, ChengH, FangX, et al. Modified reversed superficial peroneal artery flap in the reconstruction of ankle and foot defects following severe burns or trauma[J]. Burns, 2017, 43(4):839-845. DOI: 10.1016/j.burns.2016.12.003.
[27]	熊胜, 巨积辉, 金光哲, 等. 彩超定位下游离腓浅动脉穿支皮瓣修复手足部创面[J].中华手外科杂志,2018,34(6):418-420. DOI: 10.3760/cma.j.issn.1005-054X.2018.06.007.
[28]	CavadasP C , Sanz-Gim??Nez-RicoJ R , ArturoG D L C ,et al.The medial sural artery perforator free flap.[J].Plastic & Reconstructive Surgery, 2001, 108(6):1609-1615.DOI: 10.1016/S0375-9601(99)00638-6.
[29]	OoiA, NgM, SudirmanS, et al. The chimeric medial sural artery perforator flap as the ideal for partial tongue reconstruction: a case series and technical refinements[J]. J Plast Reconstr Aesthet Surg, 2021,74(10):2613-2621. DOI: 10.1016/j.bjps.2021.03.024.
[30]	SunQW, GaoPF, WangCX, et al. Anatomical study and clinical application of medial sural artery perforator flap for oral cavity reconstruction[J]. Ann Anat, 2020,227:151418. DOI: 10.1016/j.aanat.2019.151418.
[31]	HsiehYH, WeiHI, HsuCC, et al. Evolution and diversity of medial sural artery perforator flap for hand reconstruction[J]. Hand Clin, 2024,40(2):209-220. DOI: 10.1016/j.hcl.2023.08.008.
[32]	Al-HimdaniS, DinA, WrightTC, et al. The medial sural artery perforator (MSAP) flap: a versatile flap for lower extremity reconstruction[J]. Injury, 2020,51(4):1077-1085. DOI: 10.1016/j.injury.2020.02.060.
[33]	方军, 赵光宗, 李华壮, 等. 三维CT血管造影辅助游离腓肠内侧动脉穿支皮瓣修复足部创面的疗效[J].中华烧伤与创面修复杂志,2023,39(4):343-349. DOI: 10.3760/cma.j.cn501225-20220930-00430.
[34]	唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识[J].中华显微外科杂志,2016,39(2):105-106. DOI: 10.3760/cma.j.issn.1001-2036.2016.02.001.
[35]	赵风景, 姚建民, 楼佳庆, 等. 腓肠内侧动脉分叶皮瓣的解剖学研究及在手、足部软组织缺损中的应用[J].中华手外科杂志,2016,32(4):300-303. DOI: 10.3760/cma.j.issn.1005-054X.2016.04.025.
[36]	SuiX, KhanUZ, QingL, et al. The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities[J]. Int Wound J, 2023,20(7):2679-2687. DOI: 10.1111/iwj.14142.
[37]	NarayanN, BernerJE, SaeedA, et al. Outcomes of the pedicled medial sural artery perforator flap for soft tissue reconstruction around the knee: when to use it and how to look after it[J]. J Hand Microsurg, 2022,14(3):216-221. DOI: 10.1055/s-0040-1715919.
[38]	郭万里,段鹏,明志国,等. 基于皮瓣经济学理论修复头面颈部毁损性高压电烧伤创面1例[J]. 中华烧伤与创面修复杂志,2024,40(1):87-89. DOI: 10.3760/cma.j.cn501225-20231101-00170.
[39]	ZhengH, LiuJ, DaiX, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand[J]. J Plast Reconstr Aesthet Surg, 2015,68(4):565-570. DOI: 10.1016/j.bjps.2014.12.031.
[40]	ChoBC, LeeJH, WeinzweigN, et al. Use of the free innervated dorsalis pedis tendocutaneous flap in composite hand reconstruction[J]. Ann Plast Surg, 1998,40(3):268-276. DOI: 10.1097/00000637-199803000-00013.
[41]	ZhouZ, JuJ, XingP, et al. Efficacy and safety of free medial plantar flap in repair of the high-voltage electrical burns in hands[J]. Eur J Trauma Emerg Surg, 2022,48(2):1381-1387. DOI: 10.1007/s00068-021-01700-5.