手腕部重度电烧伤创面的修复与功能重建

目的：总结降低手腕部严重高压电烧伤后肢体截肢率，并恢复手部分功能。方法：1987年－1999年收治手腕部重度高压电烧伤44例55个肢体，早期充分减张，有血运障碍及时行血管重建手术，及时扩创，应用胸，腹部或腹股沟部皮瓣形成单蒂，双蒂或联全皮瓣修复创面，同时行抗栓，抗凝及抗炎治疗，创面修复后，进行手部感觉和运动功能重建，采用自体或异体肌腱移植修复肌腱缺损以及肌腱移位恢复手部功能，自体神经或胎儿神经睡复神经缺损。结果：III型截肢率为43．8％，自体肌腱移植按TAM标准均达良级；异体肌腱移植达可级，腓肠神经移植7例，胎儿神经移植1例，手指感觉恢复好，手内在肌功能部分恢复，结论：重建腕部血管通路，皮瓣修复创面，及时重建运动和感觉功能是减少手腕部重度电烧伤截肢率和恢复手部分功能的有效方法。

REPAIR AND FUNCTIONALRECONSTRUCTION OF SEVERE ELECTRICAL BURNS OF WRIST

OBJECTIVE: To reduce amputation rate of severe electrical burn of wrist and to promote partial recovery of the injuried hand. METHODS: From 1987 to 1999, 44 cases, with 55 limbs of severe electrical burn were classified into 4 types, according to criteria of Dr Shen Zuyao, and were all treated by primary adequate decompression, timely debridement, reconstruction of blood circulation in cases complicated with blood vessel injury, and skin flap grafting from chest, abdomen or inguinal area, followed by treatment of anti-coaggluation and anti-infection. Once the wound healed, auto- or allo-transplantation or transferring of tendons were performed to repair tendon defect, and auto-nerve or fetal nerve transplantation performed for nerve defect. RESULTS: After the primary treatment of the 55 burned limbs, all limbs of type IV were amputated, and most of other 3 types survived. The function, including sensation and movement, of survived hands partially recovered. CONCLUSION: Primary reconstruction of blood circulation, cover of wound with skin flap, and timely repair of sensation and motor function are very crucial approach to reduce amputation rate and to promote the survived hand function of severe electrical burns of wrists.