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Volume 39 Issue 8
Aug.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(8): 731-737
Zhang W,Chen L,Yang F,et al.Treatment methods of upper limbs with destructive electric burns and its clinical efficacy[J].Chin J Burns Wounds,2023,39(8):731-737.DOI: 10.3760/cma.j.cn501225-20230530-00188.
Citation: Zhang W,Chen L,Yang F,et al.Treatment methods of upper limbs with destructive electric burns and its clinical efficacy[J].Chin J Burns Wounds,2023,39(8):731-737.DOI: 10.3760/cma.j.cn501225-20230530-00188.
shu

Treatment methods of upper limbs with destructive electric burns and its clinical efficacy

doi: 10.3760/cma.j.cn501225-20230530-00188

  • Department of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan 430060, China

Funds:

Scientific Research Fund of Health Commission of Hubei Province of China WJ2019H433

Clinical Medical Research Project of Wuhan WX17A03, WX11A04

Medical Science and Research Project of Wuhan WG19B02

More Information
  • Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com
  • Received Date: 2023-05-30
    Abstract
  •   Objective   To investigate the treatment methods of upper limbs with destructive electric burns and its clinical efficacy.   Methods   A retrospective observational study was conducted. From July 2014 to December 2020, 20 male patients with destructive electric burns in upper limbs who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, aged from 21 to 57 years, of whom 7 patients underwent emergency surgery, and a total of 20 affected limbs were treated with limb salvage. The necrotic bone was resected in 5 affected limbs, the residual hand and wrist at the distal end of left affected limb was replanted to the residual end of the right forearm in one patient in a cross heterotopic way, and short reduction and replantation after osteotomy were performed for two affected limbs with distal ulnar and radial necrosis. After thorough debridement, the area of wound proposed to be repaired by tissue flap was from 12 cm×7 cm to 58 cm×13 cm. According to the size and distribution of wound, the wounds of 2 affected limbs were repaired by transplantation of pedicled latissimus dorsi myocutaneous flap and free groin flap with vascular anastomosis. The wounds of the remaining 17 affected limbs were repaired with the transplantation of free latissimus dorsi myocutaneous flap, anterolateral thigh flaps, and paraumbilical perforator flap, with 10 affected limbs with larger wounds being jointly transplanted with the groin flap or the paraumbilical perforator flap on the other side. The total grafted tissue flap area was 20 cm×8 cm to 52 cm×20 cm. During tissue flap transplantation, according to the length of blood vessel defect in the affected limb, the distal artery of the affected limb was bridged with the distal part of flap vascular pedicle, undamaged vein on the affected side, superficial vein of abdominal wall, and great saphenous vein, etc., in 14 affected limbs, and the great saphenous vein was grafted in 3 of them with impeded distal return for recanalization of distal limb veins. The wound in the donor area was repaired by direct suture or grafting with split-thickness scalp. After the wound was basically healed, the functional rehabilitation training was started gradually, and the functional reconstruction and scar rectification surgery were started 3 months after tissue flap transplantation. The survival of tissue flaps/skin grafts, wound healing, limb salvage, and follow-up status after surgery were recorded. At the last follow-up, the function of the successfully salvaged limb was evaluated and scored by the disabilities of the arm, shoulder and hand (DASH) scoring scale.   Results   After surgery, the grafted tissue flap in the affected limb and the skin grafts transplanted on the wound at flap donor site survived, and wounds at the recipient and donor sites healed well. Two affected limbs had distal necrosis within 10 days after tissue flap transplantation, and the middle and upper forearms were amputated. The remaining 18 affected limbs were successfully salvaged (including shortened replantation and cross heterotopic replantation). During 6-48 months of follow-up, 5 affected limbs that were successfully salvaged developed aseptic dissolution of residual tendon and bone tissue 3 to 18 months after tissue flap transplantation, which gradually healed after surgical debridement combined with vacuum sealing drainage treatment. At the last follow-up, the stump of two affected limbs healed well after amputation; 18 affected limbs that were successfully salvaged all survived well, of which 8 affected limbs had good recovery of finger flexion and extension function and thumb opponensplasty and could complete daily activities independently, 9 affected limbs regained partial mobility and could complete daily activities such as dressing and eating with the assistance of the opposite upper limb or auxiliary devices, and one affected limb had no function. At the last follow-up, the functional scores of DASH scoring scale of the 18 affected limbs that were successfully salvaged ranged from 30.0 to 100.   Conclusions   Timely surgical debridement, proper treatment of the injured bone tissue, effective vascular bridging for reconstruction of the distal artery of the affected limb, and the use of blood-rich tissue flap to repair the wound, combined with early rehabilitation and functional restoration treatment, are beneficial to salvage the upper limb with destructive electric burns and improve the function of the affected limb.

     

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    • References(21)
  • [1]
    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.
    [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]
    陈振兵,洪光祥,王发斌.上肢功能评定表[J].中国修复重建外科杂志,2004,18(6):520-521.
    [4]
    TarimA,EzerA.Electrical burn is still a major risk factor for amputations[J].Burns,2013,39(2):354-357.DOI: 10.1016/j.burns.2012.06.012.
    [5]
    尹凯,程琳,杜伟力,等.169例腕部高压电烧伤住院患者流行病学调查[J].中华烧伤杂志,2020,36(6):433-439.DOI: 10.3760/cma.j.cn501120-20200304-00119.
    [6]
    魏在荣,杨成兰,蒋玲丽.深度电烧伤创面的皮瓣修复[J/CD].中华损伤与修复杂志(电子版),2022,17(2):100-105.DOI: 10.3877/cma.j.issn.1673-9450.2022.02.002.
    [7]
    吴攀峰,黄承雄,卿黎明,等.联体穿支皮瓣游离移植修复四肢环形皮肤软组织缺损[J].中华手外科杂志,2021,37(5):325-328.DOI: 10.3760/cma.j.cn311653-20201117-00373.
    [8]
    张伟,谢卫国,杨飞,等.游离股前外侧穿支皮瓣分叶移植在四肢电烧伤治疗中的临床应用[J].中华烧伤杂志,2019,35(11):790-797.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.005.
    [9]
    刘东,欧昌良,周鑫,等.股前外侧穿支皮瓣与腹壁下动脉穿支皮瓣修复大面积下肢软组织缺损的疗效比较[J].创伤外科杂志,2021,23(6):412-416.DOI: 10.3969/j.issn.1009-4237.2021.06.003.
    [10]
    唐林,周鑫,黄宇,等.基于旋髂浅动脉设计的联体皮瓣修复下肢大面积软组织缺损[J].中华显微外科杂志,2022,45(2):175-180.DOI: 10.3760/cma.j.cm441206-20211210-00290.
    [11]
    周鑫,邹永根,唐林,等.携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损[J].中国修复重建外科杂志,2021,35(11):1467-1471.DOI: 10.7507/1002-1892.202106040.
    [12]
    谢庆平,穆籣,刘元波,等.腹壁下动脉穿支皮瓣专家共识[J].中华显微外科杂志,2020,43(5):417-423.DOI: 10.3760/cma.j.cn441206-20200826-00331.
    [13]
    刘洋,宋达疆,谢松林,等.游离修薄腹壁下动脉穿支皮瓣修复四肢大面积软组织缺损的临床效果[J].中华烧伤杂志,2020,36(7):590-593.DOI: 10.3760/cma.j.cn501120-20190415-00185.
    [14]
    Saint-CyrM,DaigleJP.Early free tissue transfer for extremity reconstruction following high-voltage electrical burn injuries[J].J Reconstr Microsurg,2008,24(4):259-266.DOI: 10.1055/s-2008-1078697.
    [15]
    王冬月,李新星,曲鑫,等.Flow-through股前外侧皮瓣修复前臂大面积软组织合并尺动脉或桡动脉缺损[J].中国医科大学学报,2021,50(7):664-666.DOI: 10.12007/j.issn.0258-4646.2021.07.021.
    [16]
    胡浩良,李学渊,田敏涛,等.内增压技术在游离穿支皮瓣修复大面积皮肤缺损创面中的应用[J].中华整形外科杂志,2019,35(9):862-867.DOI: 10.3760/cma.j.issn.1009-4598.2019.09.004.
    [17]
    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.
    [18]
    UsluA.Reconstruction of the distal leg and foot using free anterolateral thigh flaps in patients with high-voltage electrical burns[J].J Burn Care Res,2019,40(5):703-709.DOI: 10.1093/jbcr/irz070.
    [19]
    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.
    [20]
    薛佳杰,王耀军,任忠亮,等.Flow-through旋股外侧动脉降支穿支皮瓣在上肢高压电击伤保肢治疗中的应用[J].中国临床解剖学杂志,2021,39(6):707-710.DOI: 10.13418/j.issn.1001-165x.2021.06.015.
    [21]
    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.
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