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Volume 40 Issue 9
Sep.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(9): 818-827
Zhang W,Zhang WD,Chen L,et al.Strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds[J].Chin J Burns Wounds,2024,40(9):818-827.DOI: 10.3760/cma.j.cn501225-20240609-00218.
Citation: Zhang W,Zhang WD,Chen L,et al.Strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds[J].Chin J Burns Wounds,2024,40(9):818-827.DOI: 10.3760/cma.j.cn501225-20240609-00218.
shu

Strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds

doi: 10.3760/cma.j.cn501225-20240609-00218

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

Funds:

Natural Science Foundation of Hubei Province of China 2024AFB470

Knowledge Innovation Program of Wuhan-Shuguang Project 2022020801020553

Clinical Medical Research Project of Wuhan WX20Q18

More Information
  • Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com
  • Received Date: 2024-06-09
    Abstract
  •   Objective  To investigate the strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds.  Methods  This study was a retrospective observational study. From June 2014 to October 2023, 51 burn patients with 53 massive destructive burn wounds which met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 47 males and 4 females, aged 21 to 77 years. After debridement, the wound area needed to be repaired by tissue flaps ranged from 20.0 cm×12.5 cm to 50.0 cm×15.0 cm. Emergency, early, or delayed transplantation of tissue flaps was performed to repair the wounds. Six head, face, and neck wounds, 5 upper limb wounds, and 1 lower limb wound were repaired with latissimus dorsi myocutaneous flaps. Eleven upper limb wounds and 6 lower limb wounds were repaired with anterolateral thigh flaps. Seven upper limb wounds, 5 lower limb wounds, and 2 face and neck wounds were repaired with paraumbilical perforator flaps. One lower limb wound was repaired with lower abdominal flap. Two face and neck wounds, 2 upper limb wounds, and 1 lower limb wound were repaired with inguinal flaps. One upper limb wound was repaired with scapular flap. One trunk wound was repaired with the "fillet flap" from the abandoned upper limb after amputation. Three head, face, and neck wounds, 3 lower limb wounds, and 1 upper limb wound were repaired with omental flaps. Four wounds were repaired by combined transplantation of the above-mentioned tissue flaps. Three wounds were repaired by fractional transplantation of the above-mentioned tissue flaps. The size of a single harvested tissue flap ranged from 15.0 cm×5.0 cm to 45.0 cm×25.0 cm. The arterial and venous anastomoses were added as the circumstances might require to improve tissue flap circulation. The wounds in the flap donor sites were sutured directly or repaired by split-thickness skin grafts from head. The general condition of patients during treatment was recorded. After surgery, the survival of tissue flaps, the healing of wounds in the recipient sites, limb salvage, the healing of wounds in the flap donor sites, and the survival of skin grafts were observed. The healing of wounds in the recipient sites was observed during follow-up. At the last follow-up, the upper limb function after successful limb salvage was evaluated by the Arm, Shoulder, and Hand Disability Scoring Scale, the weight-bearing walking ability of patients with successful lower limb salvage was evaluated by the Holden walking ability classification, and the patient's satisfaction with the efficacy was assessed by 5-grade Likert scale.  Results  During treatment, one case with electrical burn of the head suffered from aggravated cerebral edema, cerebral hernia and coma recurred. After dehydration, hormone therapy, and so on, the patient recovered and incomplete hemiplegia on the right limb was left. The shock symptoms of 4 patients got worse, which were gradually controlled after anti-shock with fluid supplement and colloid injection. One patient developed hemorrhagic shock after tissue flap transplantation, which was corrected by fluid infusion and red blood cell suspension transfusion. Vascular crisis occurred in 3 tissue flaps after surgery, of which 2 survived and 1 eventually became necrotic after exploration. Partial necrosis occurred in 2 tissue flaps and slight necrosis occurred at the edge of 5 tissue flaps, which all healed after tissue flap trimming, vacuum sealing drainage (VSD), and skin grafting treatment. All the other tissue flaps survived. There were 12 recipient wounds with residual necrotic tissue after surgery, which healed after debridement, VSD, and skin grafting treatment. The remaining 41 wounds healed well. Among the 40 limb wounds of 39 patients, 5 patients had 3 upper limb and 2 lower limb amputations. The remaining 35 limbs of 34 patients were successfully salvaged. The donor site wounds healed well, and the skin grafts survived well. During the follow-up of 6 to 52 months, all the head, face, neck, and trunk wounds were well repaired. The fester recurred in 7 limb wounds 3 to 9 months after surgery and healed after debridement, drainage, and tissue flap repair. At the last follow-up, the functional scores of 22 upper limbs after successful limb salvage ranged from 0 to 100 (with an average of 50), and the Holden walking ability classification of 12 patients with 13 lower limbs after successful limb salvage was level Ⅴ in 8 cases, level Ⅳ in 2 cases, and level Ⅲ in 2 cases. The patients were very satisfied with the efficacy in 33 cases, relatively satisfied in 12 cases, and not quite satisfied in 6 cases.  Conclusions  Systematic evaluation and treatment of the whole body condition, choosing the appropriate repair time, and using appropriate tissue flaps to repair massive destructive burn wounds will help ensure the safety of treatment, improve the repair effect, and reduce the injury of donor sites, thus optimizing the repair effect.

     

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    • References(37)
  • [1]
    张丕红. 毁损伤的成因与评估及其修复策略优化探讨[J]. 中华烧伤杂志,2021,37(7):601-605. DOI: 10.3760/cma.j.cn501120-20210119-00029.
    [2]
    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.
    [3]
    FarrellyE, TaraporeR, LindseyS, et al. Management of the mangled extremity[J]. Surg Clin North Am, 2024,104(2):385-404. DOI: 10.1016/j.suc.2023.10.006.
    [4]
    沈余明.毁损性创面的修复策略[J/CD].中华损伤与修复杂志(电子版),2019,14(2):81-84.DOI: 10.3877/cma.j.issn.1673-9450.2019.02.001.
    [5]
    ChangTN, HsuCC, DafyddH, et al. Heterotopic digital replantation in mutilating hand injuries: an algorithmic approach based on 53 cases and literature review[J]. J Reconstr Microsurg, 2023,39(7):573-580. DOI: 10.1055/s-0043-1761288.
    [6]
    张玉峰,王晨霖,徐杰,等.封闭负压吸引技术联合游离股前外侧穿支皮瓣修复手部大面积软组织缺损[J].实用手外科杂志,2022,36(2):167-169,209.DOI: 10.3969/j.issn.1671-2722.2022.02.010.
    [7]
    梁尊鸿,潘云川,林志琥,等.游离股前外侧皮瓣及头皮扩张术序贯治疗头皮大面积缺损并颅骨外露感染创面[J].中华显微外科杂志,2018,41(2):186-188.DOI: 10.3760/cma.j.issn.1001-2036.2018.02.024.
    [8]
    ZeidermanMR, PuLLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL]. Burns Trauma, 2021,9:tkab024[2024-06-09]. https://pubmed.ncbi.nlm.nih.gov/34345630/. DOI: 10.1093/burnst/tkab024.
    [9]
    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.
    [10]
    KrześniakNE, HsuCC, ChenSH, et al. Exploring the role of free tissue transfers in the preservation of bone length and knee joint function after lower limb trauma: a retrospective analysis[J]. J Pers Med, 2024,14(2):160. DOI: 10.3390/jpm14020160.
    [11]
    覃凤均,王成,张颖,等.游离皮瓣联合血管重建在上肢毁损性创面合并血管损伤修复中的应用[J].中国普通外科杂志,2023,32(6):840-849.DOI: 10.7659/j.issn.1005-6947.2023.06.005.
    [12]
    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.
    [13]
    杨国敬,陈德松,蔡佩琴.背阔肌皮瓣移位重建屈肘功能12例[J].中国修复重建外科杂志,1995,9(4):209-211.DOI: 10.3321/j.issn:1002-1892.1995.04.011.
    [14]
    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.
    [15]
    张盼,李雷,唐林峰,等.不同闭合方式的背阔肌肌皮瓣移植术后供区并发症的分析[J].中国美容整形外科杂志,2024,35(3):133-135.DOI: 10.3969/j.issn.1673-7040.2024.03.002.
    [16]
    马超,陶然,舒军,等.背阔肌肌皮瓣修复较大软组织缺损的方法及供区继发创面的处理[J].中华烧伤杂志,2020,36(12):1199-1203.DOI: 10.3760/cma.j.cn501120-20191121-00439.
    [17]
    KoshimaI,YamamotoH,HosodaM,et al.Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle[J].Plast Reconstr Surg,1993,92(3):411-420.DOI: 10.1097/00006534-199309000-00004.
    [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]
    LeeYJ, KimJ, LeeCR, et al. Anterolateral thigh chimeric flap: an alternative reconstructive option to free flaps for large soft tissue defects[J]. J Clin Med, 2023,12(21):6723. DOI: 10.3390/jcm12216723.
    [20]
    柳志锦,程俊楠,杨林,等.股前外侧区组合穿支皮瓣在严重创伤肢体保肢治疗中的应用效果[J].中华外科杂志,2022,60(5):486-489.DOI: 10.3760/cma.j.cn112139-20210804-00357.
    [21]
    文根,柴益民,吴旭华,等.股前外侧皮瓣供区并发症的防治[J].中华显微外科杂志,2009,32(6):461-463.DOI: 10.3760/cma.j.issn.1001-2036.2009.06.010.
    [22]
    覃凤均,沈余明,杜伟力,等.带腹壁下血管的脐旁穿支皮瓣在毁损性创面修复中的应用策略及临床效果[J].中华烧伤杂志,2021,37(7):606-613.DOI: 10.3760/cma.j.cn501120-20210310-00082.
    [23]
    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.
    [24]
    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.
    [25]
    任磊,扈克治,吕波,等.应用分叶股前外侧穿支皮瓣避免大创面修复中第二供区的损伤[J].创伤外科杂志,2022,24(1):57-62.DOI: 10.3969/j.issn.1009-4237.2022.01.000.
    [26]
    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.
    [27]
    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治疗上肢大面积组织缺损[J].中华手外科杂志,2019,35(3):183-185.DOI: 10.3760/cma.j.issn.1005-054X.2019.03.008.
    [28]
    张绪生,徐燕,于晟.电击伤废弃上肢皮瓣修复胸肩部创面一例[J].中华显微外科杂志,1997,20(3):203.DOI: 10.3760/cma.j.issn.1001-2036.1997.03.120.
    [29]
    赵玉华,邵文年.废弃手掌皮瓣截肢残端寄养联合二期移植修复足底创面一例[J].中华手外科杂志,2019,35(2):155.DOI: 10.3760/cma.j.issn.1005-054X.2019.02.027.
    [30]
    QianY, SongJ, ZhengX. Free fillet flap transplantation using amputated upper limbs for shoulder defect coverage and joint function salvage in emergency treatment-a case report[J]. Int J Surg Case Rep, 2023,106:108176. DOI: 10.1016/j.ijscr.2023.108176.
    [31]
    张小锋,王爱武,燕归如,等.腹腔镜下切取大网膜游离移植联合植皮术修复下肢大面积难愈性创面[J].中华整形外科杂志,2021,37(2):187-191.DOI: 10.3760/cma.j.cn114453-20200311-00135.
    [32]
    BhatiaVY,MenonPA,BhavsarM.Coverage of chest wall defect in a case of electric burns by pedicled omental flap[J].J Burn Care Res,2014,35(4):e262-264.DOI: 10.1097/BCR.0b013e318299d580.
    [33]
    宋达疆,李赞,章一新,等.移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果[J].中华烧伤杂志,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.
    [34]
    巨积辉,周荣,刘跃飞,等.超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果[J].中华烧伤杂志,2019,35(7):495-500.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.004.
    [35]
    ZhuY, YooH, MinS, et al. Efficacy of superficial inferior epigastric vein superdrainage in free TRAM and DIEP flap: an indocyanine green angiography study of 68 cases[J]. J Plast Reconstr Aesthet Surg, 2023,84:385-391. DOI: 10.1016/j.bjps.2023.06.006.
    [36]
    郑俊,习珊珊,李红,等.静脉超引流与动脉增压对皮瓣存活的影响[J].解剖学报,2016,47(3):359-364.DOI: 10.16098/j.issn.0529-1356.2016.03.012.
    [37]
    胡朝波,裴世杰,孔令福,等.血管增压和超回流技术在游离股前外侧皮瓣中的临床应用[J].中华显微外科杂志,2023,46(3):241-246.DOI: 10.3760/cma.j.cn441206-20220417-00076.
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