巨大腹壁下动脉脐旁穿支皮瓣修复腕部环状高压电烧伤创面的临床效果

杜伟力; 沈余明; 胡骁骅; 覃凤均; 程琳

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

巨大腹壁下动脉脐旁穿支皮瓣修复腕部环状高压电烧伤创面的临床效果

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

北京积水潭医院烧伤科，北京　　100035

基金项目:

国家重点研发计划 2018YFA0703104

首都卫生发展科研专项 2020-2-1123

北京积水潭医院学科骨干 XKGG202209

详细信息

通讯作者:
沈余明，Email：shenyuming1963@163.com

计量
- 文章访问数: 1056
- HTML全文浏览量: 86
- PDF下载量: 80
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-19

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

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

摘要

摘要: 目的探讨巨大腹壁下动脉脐旁穿支皮瓣修复腕部环状高压电烧伤创面的临床效果。方法采用回顾性观察性研究方法。2016年9月—2021年10月，北京积水潭医院收治13例腕部环状高压（10~100 kV）电烧伤男性患者（年龄20~43岁）。伤后早期，对患者腕部行切开减张术、清创术，清创后创面面积为27 cm×16 cm~32 cm×19 cm；对12例血管存在损伤者，采用长度15~25 cm大隐静脉移植重建桡动脉或尺动脉；采用腹壁下动脉脐旁穿支皮瓣（若创面巨大，须携带其他穿支的下腹部皮瓣）游离移植修复腕部创面，皮瓣切取面积为30 cm×19 cm~35 cm×20 cm。供瓣区采用直接拉拢缝合+皮片移植修复或接力皮瓣移植修复。术后，观察受区皮瓣成活情况、供瓣区皮片或皮瓣成活情况。随访时，观察受区皮瓣外形及手功能恢复情况、供瓣区愈合及是否发生腹壁疝与移植皮片区瘢痕等情况。结果术后，13例患者脐旁穿支皮瓣均成活，其中3例患者腕侧皮瓣远端皮下脂肪坏死，创面存在轻度感染，经再次扩创+换药后愈合；10例患者供瓣区移植皮片全部成活，3例患者供瓣区接力皮瓣存活良好。随访6个月~3年，受区皮瓣外形良好，手功能部分恢复者8例，手指屈曲功能丧失者5例；腹部供瓣区愈合良好，无腹壁疝发生，其中移植皮片区无明显瘢痕增生且质地柔软。结论伤后早期行血管重建+巨大腹壁下动脉脐旁穿支皮瓣游离移植修复腕部环状高压电烧伤创面，效果良好。
- 烧伤，电 /
- 穿支皮瓣 /
- 显微外科手术 /
- 环状创面 /
- 血管重建 /
- 创面修复
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
杜伟力：管理患者、实施手术、撰写文章；沈余明：指导手术的设计与实施过程；胡骁骅：指导文章撰写；覃凤均：实施手术；程琳：实施手术、收集数据

所有作者均声明不存在利益冲突

HTML全文

参考文献(31)

[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.

下载: 全尺寸图片幻灯片

1 腹壁下动脉脐旁穿支皮瓣（携带下腹部皮瓣）游离移植修复例1患者右腕部高压电烧伤环形创面。1A、1B.分别为术前腕部创面背侧及屈侧情况；1C.血管造影示尺动脉中远端无血流，桡动脉远端有2处明显狭窄；1D.腕部清创后，切取大隐静脉拟移植重建桡动脉；1E.设计皮瓣；1F.皮瓣游离移植术后即刻；1G.切取皮瓣后，用异体脱细胞真皮基质加强腹壁力量并取大腿薄中厚皮移植覆盖；1H、1I、1J.分别为术后18个月随访时显示右腕皮瓣愈合良好、右手功能良好、腹部供瓣区异体脱细胞真皮基质上的移植皮片存活良好且无腹壁疝发生

下载: 全尺寸图片幻灯片

2 腹壁下动脉脐旁穿支皮瓣游离移植修复例2患者左腕部高压电烧伤环形创面。2A、2B.分别为术前腕部创面屈侧及背侧情况；2C.血管造影示尺动脉中远端无血流，桡动脉通畅；2D.清创后，取大隐静脉待移植；2E.右侧脐旁皮瓣设计；2F.采用大隐静脉重建尺动脉后，取脐旁穿支皮瓣待移植；2G、2H.分别为皮瓣移植后即刻屈侧及背侧情况；2I、2J.分别为皮瓣移植术后10个月随访时屈侧及背侧情况，皮瓣外形可且手指屈伸功能可，部分抓握功能恢复，但对掌功能障碍

下载: 全尺寸图片幻灯片