高压电烧伤家兔球结膜微循环变化和己酮可可碱干预作用

Objective To study the changes in bulbar conjunctiva microcirculation (BCM) and the therapeutic effect of Pentoxifylline on BCM disturbance after high-voltage electrical burn (HEB) in rabbits. Methods Forty-five rabbits were divided into control group (C) , electrical burn group (EB) , and Pentoxifylline treatment group (PT) according to random number table, with 15 rabbits in each group. Model of HEB was reproduced in rabbits from EB and PT groups with voltage regulator and experimental transformer. Rabbits in C group were sham injured with the same devices without electrification. Changes in BCM were observed with microcirculation microscope at 15 minutes before HEB and 5 minutes, 1, 2, 4, 8 hour (s) post HEB (PHM or PHH) , including: (1) morphology of microvessels, such as the descemibleness, diameters of arterioles, venules, and capillaries, the unevenness in caliber, and ischemic area; (2) dynamic changes in microvascular blood flow, such as blood flow speed in arterioles, venules, and capillaries, erythrocyte aggregation, and microthrombi formation; (3) condition of tissues surrounding microvessel, such as bleeding and exudation. Measurement data were processed with t test; enumeration data were processed with Fisher's exact test. Results (1) Morphology of microvessel: descernibleness of microvessels in EB and PT groups was decreased, but that of PT group was better than that of EB group. At PHM 5 , diameter of ar-terioles, venules and capillaries was respectively (7. 3 ± 2. 5) , (12. 3 ± 2. 4) , (3. 5 ± 0. 7) μm in EB group, all narrower than those of the control group [(14.6 ±3. 1) , (27.2±3.5), (9.0±1.4) μm, with t value respectively 5. 23 , 13. 66, 14. 04, P values all below 0. 05]. Diameters of the microvessels in PT group [(10. 2 ±3.8) , (21.5±3.1), (7. 1 ±1.2) μm] were larger than those in EB group (with t value respectively 2. 21 , 8. 99, 10. 18, P values all below 0. 05). Diameters of arterioles, venules and capillaries in EB and PT groups recovered to the before HEB size at PHH 1. From PHH 2 to 8, arterioles and capillaries decreased gradually in caliber, venules dilated gradually in EB and PT groups, but the changes in PT group were not obvious. Thickness of microvessel was observed uneven in EB group at PHM 5, which lasted until PHH 8. Ischemia of the tissue was observed in EB group at PHM 5, which improved at PHH 2. Situation in PT group was better. (2) Dynamic changes in microvascular blood flow; at PHM 5, blood flow speed in arterioles, venules and capillaries was respectively (202 ±53), (198 ± 44) , (46 ±12) μm/s in EB group, all slower than those of the control group [(544 ± 37) , (359 ± 32) , (220 ± 19) μm/s, with t value respectively 20.47, 11. 51, 30. 02, P values all below 0.05] , and those of PT group [(335 ± 42) , (260 ± 35), (119 ± 23) μm/s] were faster than those of EB group (with t value respectively 7. 55 , 4. 26, 14. 85, P values all below 0.05). Blood flow speed in EB and PT groups recovered to the before HEB level at PHH 1. From PHH 2 to 8, blood flow speed decreased gradually in EB and PT groups, but that of PT group was faster than that of EB group. Erythrocyte aggregation in venules and capillaries was observed in EB group at PHM 5, which eased up at PHH 1 , but aggregated at PHH 2, lasting until PHH 8. Obvious microthrombi were observed in EB group at PHH 2, which increased gradually. These changes were less obvious in PT group. (3) Condition of surrounding tissues of microvessel: in EB group, exudation was observed around microvessels at PHH 1, bleeding at PHH 2, with a worsening tendency. Changes in those in PT group were less obvious. Conclusions HEB causes disturbance in BCM, but it can be ameliorated by Pentoxifylline.     

高压电烧伤家兔球结膜微循环变化和己酮可可碱干预作用

Objective To study the changes in bulbar conjunctiva microcirculation (BCM) and the therapeutic effect of Pentoxifylline on BCM disturbance after high-voltage electrical burn (HEB) in rabbits. Methods Forty-five rabbits were divided into control group (C) , electrical burn group (EB) , and Pentoxifylline treatment group (PT) according to random number table, with 15 rabbits in each group. Model of HEB was reproduced in rabbits from EB and PT groups with voltage regulator and experimental transformer. Rabbits in C group were sham injured with the same devices without electrification. Changes in BCM were observed with microcirculation microscope at 15 minutes before HEB and 5 minutes, 1, 2, 4, 8 hour (s) post HEB (PHM or PHH) , including: (1) morphology of microvessels, such as the descemibleness, diameters of arterioles, venules, and capillaries, the unevenness in caliber, and ischemic area; (2) dynamic changes in microvascular blood flow, such as blood flow speed in arterioles, venules, and capillaries, erythrocyte aggregation, and microthrombi formation; (3) condition of tissues surrounding microvessel, such as bleeding and exudation. Measurement data were processed with t test; enumeration data were processed with Fisher's exact test. Results (1) Morphology of microvessel: descernibleness of microvessels in EB and PT groups was decreased, but that of PT group was better than that of EB group. At PHM 5 , diameter of ar-terioles, venules and capillaries was respectively (7. 3 ± 2. 5) , (12. 3 ± 2. 4) , (3. 5 ± 0. 7) μm in EB group, all narrower than those of the control group [(14.6 ±3. 1) , (27.2±3.5), (9.0±1.4) μm, with t value respectively 5. 23 , 13. 66, 14. 04, P values all below 0. 05]. Diameters of the microvessels in PT group [(10. 2 ±3.8) , (21.5±3.1), (7. 1 ±1.2) μm] were larger than those in EB group (with t value respectively 2. 21 , 8. 99, 10. 18, P values all below 0. 05). Diameters of arterioles, venules and capillaries in EB and PT groups recovered to the before HEB size at PHH 1. From PHH 2 to 8, arterioles and capillaries decreased gradually in caliber, venules dilated gradually in EB and PT groups, but the changes in PT group were not obvious. Thickness of microvessel was observed uneven in EB group at PHM 5, which lasted until PHH 8. Ischemia of the tissue was observed in EB group at PHM 5, which improved at PHH 2. Situation in PT group was better. (2) Dynamic changes in microvascular blood flow; at PHM 5, blood flow speed in arterioles, venules and capillaries was respectively (202 ±53), (198 ± 44) , (46 ±12) μm/s in EB group, all slower than those of the control group [(544 ± 37) , (359 ± 32) , (220 ± 19) μm/s, with t value respectively 20.47, 11. 51, 30. 02, P values all below 0.05] , and those of PT group [(335 ± 42) , (260 ± 35), (119 ± 23) μm/s] were faster than those of EB group (with t value respectively 7. 55 , 4. 26, 14. 85, P values all below 0.05). Blood flow speed in EB and PT groups recovered to the before HEB level at PHH 1. From PHH 2 to 8, blood flow speed decreased gradually in EB and PT groups, but that of PT group was faster than that of EB group. Erythrocyte aggregation in venules and capillaries was observed in EB group at PHM 5, which eased up at PHH 1 , but aggregated at PHH 2, lasting until PHH 8. Obvious microthrombi were observed in EB group at PHH 2, which increased gradually. These changes were less obvious in PT group. (3) Condition of surrounding tissues of microvessel: in EB group, exudation was observed around microvessels at PHH 1, bleeding at PHH 2, with a worsening tendency. Changes in those in PT group were less obvious. Conclusions HEB causes disturbance in BCM, but it can be ameliorated by Pentoxifylline.     

高压电烧伤对大鼠血小板与白细胞流变性的影响及己酮可可碱的干预作用

目的 了解高压电烧伤对大鼠血小板、白细胞聚集黏附的影响,探讨己酮可可碱(PTX)的干预作用. 方法 将180只SD大鼠按随机数字表法分为对照组、电伤组和治疗组,每组60只.(1)3组致伤前15 min各取10只大鼠,用布莱德多项投影显微镜系统观测肠系膜微静脉白细胞黏附数;用激光多普勒组织灌流图像仪检测胸部皮肤微循环灌流量;心脏采血分离血清,用双抗体夹心ELISA法检测血清中血小板活化因子(PAF)、血栓烷B2(TXB2)、前列环素(PGI2)、P选择素、E选择素及L选择素含量,并计算TXB2/PGI2比值.(2)电伤组和治疗组余下各50只大鼠用调压器及实验变压器制成高压电烧伤模型(左前肢为电流入口,右后肢为电流出口),对照组余下50只大鼠接相同装置但不通电致假伤.伤后2 min内,经腹腔注射2 mL生理盐水(对照组、电伤组)或者2 mL浓度为50 mg/mL PTX注射液(治疗组).伤后5 min和1、2、4、8h于每组各取10只大鼠,同前检测白细胞黏附数和微循环灌流量、血清血小板及白细胞相关因子水平,计算相关比值.对数据行两因素析因设计的方差分析和LSD检验. 结果 电伤组大鼠PAF、TXB2、PGI2、P选择素、E选择素、L选择素含量以及TXB2/PGI2比值和白细胞黏附数总体检测值大于对照组;微循环灌流量小于对照组,处理因素主效应F值为854.20～8156.52,P值均小于0.01.治疗组大鼠PAF、TXB2、P选择素、E选择素、L选择素含量以及TXB2/PGI2比值和白细胞黏附数总体检测值小于电伤组;PGI2含量、微循环灌流量大于电伤组,处理因素主效应F值为33.18～1033.99,P值均小于0.01.统计学结果仅允许在电伤组、治疗组组内进行比较.除治疗组伤后5 min TXB2/PGI2比值、电伤组和治疗组伤后5 minE选择素含量外,电伤组及治疗组大鼠伤后各时相点PAF、TXB2、PGI2、P选择素、E选择素、L选择素含量及TXB2/PGI2比值和白细胞黏附数显著大于伤前15 min;微循环灌流量显著小于伤前15 min(P值均小于0.001).电伤组PAF、TXB2、E选择素含量及TXB2/PGI2比值于伤后4h达峰值,分别为(9.3±0.9) ng/mL、(14.31±0.65)nmol/mL、(271.2±18.4) ng/mL、4.62±0.26;PGI2、P选择素含量及每100微米微静脉白细胞黏附数伤后8h达峰值,分别为(3.98±0.24) nmol/mL、(514±24) ng/mL、(25.50±4.14)个;L选择素含量于伤后2h达峰值,为(876±54) ng/mL;微循环灌流量以伤后5 min最小,为(1.17±0.10)V. 结论 高压电烧伤引起大鼠PAF、TXB2、PGI2、P选择素、E选择素、L选择索含量及TXB2/PGI2比值升高,白细胞黏附数增加及微循环灌流量下降.PTX通过增加PGI2的含量,降低上述其他因子的含量而抑制血小板及白细胞聚集黏附,从而改善电烧伤后微循环障碍.     

高压电烧伤家兔胰腺微循环的变化

目的 了解家兔高压电烧伤后胰腺微循环的变化情况.方法 将30只家兔采用简单随机法分为电伤组和对照组,每组15只.电伤组家兔用调压器和实验变压器制成高压电烧伤模型,对照组家兔接相同装置但不通电,致假伤.于伤前15 min及伤后0、1、2、4、8 h抽取2组家兔静脉血,检测其血清淀粉酶和血糖水平.同时用微循环显微镜及其图像分析系统,检测胰腺微血管形态、周围状态以及微血流变化.结果 (1)电伤组家兔伤后血清淀粉酶逐渐升高,至伤后8 h[(849±39)U/L]达高峰,而对照组却逐渐下降,伤后8 h至最低[(153±21)U/L,P<0.05].2组家兔伤后血糖均逐渐升高,但电伤组却明显高于对照组(P<0.05).(2)2组家兔伤前胰腺小叶表面的微动脉、微静脉及毛细血管网清晰可见,走行自然,分布均匀.电伤组微动脉伤后0 h收缩,伤后1 h起管径逐渐增加;微静脉伤后2 h出现粗细不均现象,伤后8 h扩张;毛细血管伤后0 h收缩、断流或完全闭塞隐没,伤后2 h粗细不均,伤后8 h管径变小.对照组各时相点微血管形态无明显变化.(3)2组家兔伤前胰腺表面微血管周围未见渗出和出血.电伤组伤后1 h微血管周围有渗出,伤后2 h开始微血管周围有出血现象,伤后4 h出血明显,伤后8 h见毛细血管渗出和片状出血.对照组伤后各时相点微血管周围无明显变化.(4)2组家兔伤前胰腺表面微血管内血流速度接近(P>0.05),均未见红细胞聚集和微血栓.电伤组伤后0 h微血管血流速度较伤前减慢,1 h时有所恢复,随后又减慢;伤后0 h起微静脉和毛细血管出现红细胞聚集并逐渐加重.对照组无上述变化.结论 高压电烧伤会导致胰腺微循环及功能障碍.     

高压电烧伤对兔心脏微循环的影响

目的 了解高压电烧伤对兔心脏微循环的影响. 方法 将120只清洁级新西兰兔按随机数字表法分为对照组和电伤组,每组60只.电伤组兔用调压器及实验变压器制成高压电烧伤模型(左前肢近心端外侧为电流入口,右后肢近心端外侧为电流出口),对照组接相同装置但不通电致假伤.于伤前15 min及伤后5 min、lh、2h、4h、8h(各组每时相点10只兔),兔开胸用激光多普勒组织灌流图像仪检测心尖表面微循环灌流量;每时相点取2只兔左心室壁心肌组织,于光学显微镜和透射电镜下进行微血管形态学观察;耳缘静脉抽血,用全自动生化分析仪检测AST、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK-MB)含量.对数据行两因素析因设计的方差分析和LSD检验. 结果 电伤组兔总体检测结果与对照组比较差异有统计学意义,处理因素主效应F值为425.991～ 3046.834,P值均小于0.01,统计学结果仅允许在电伤组内进行比较.(1)电伤组兔伤后5 min,心尖表面微循环灌流量为(1.96±0.09)V,低于伤前15 min的(4.34±0.35)V,P＜0.01;伤后1h灌流量为(3.43±0.30)V,较伤后5 min有所回升,之后呈下降趋势.(2)光学显微镜下可见电伤组兔伤后8h心肌微静脉及毛细血管出血,有微血栓形成;透射电镜下见电伤组伤后8h毛细血管内皮细胞基膜断裂、线粒体肿胀、创面内质网严重脱颗粒.(3)电伤组兔伤后1～8h血清AST、LDH、HBDH、CK、CK-MB含量均高于伤前15 min(P值均小于0.01),AST以伤后2h最高,为(164±39) U/L;LDH和HBDH以伤后4h最高,分别为(1016±246) U/L、(487±54)U/L;CK以伤后8h最高,为(7799±738) U/L;CK-MB则以伤后1h最高,为(1848±65) U/L.结论 高压电烧伤可直接损伤兔心脏微血管并改变微循环血流量,救治时应予以重视.     

己酮可可碱在肾脏疾病中的作用

己酮可可碱是一种非选择性磷酸二酯酶抑制剂,其临床应用范围很广,包括脑血管疾病、缺血性心脏病、糖尿病、眼部循环不良、性功能不良、败血症及器官移植排斥等。本文综述了己酮可可碱在肾脏疾病方面的应用。     

己酮可可碱在肾脏疾病中的作用

己酮可可碱是一种非选择性磷酸二酯酶抑制剂,其临床应用范围很广,包括脑血管疾病、缺血性心脏病、糖尿病、眼部循环不良、性功能不良、败血症及器官移植排斥等。本文综述了己酮可可碱在肾脏疾病方面的应用。     

己酮可可碱对内毒素休克家兔生物喋呤诱生的干预作用

目的　观察己酮可可碱 (PTX)对内毒素休克家兔休克时生物喋呤诱生的影响。　方法　 2 8只大耳白兔 ,随机分为 3组 ,对照组 (8只 )、内毒素休克组 (10只 )、PTX治疗组 (10只 )。制作内毒素休克模型 ,观察血浆生物喋呤、肿瘤坏死因子及组织三磷酸鸟苷环水解酶I活性的变化 ,同时监测全身血流动力学改变。　结果　内毒素休克大鼠早期给予PTX治疗 ,可显著降低血浆生物喋呤及肿瘤坏死因子水平 ,与对照组及休克组比较 ,差异有显著性意义 (P <0 0 5 ,P <0 0 1) ;不同程度地抑制肝、肺、心等组织三磷酸鸟苷环水解酶I活性 (P <0 0 5 ) ;与此同时 ,治疗组平均动脉压、心输出量及外周血管阻力均比休克组明显提高 ,差异有显著性意义 (P <0 0 5 ,P <0 0 1)。　结论　PTX能有效抑制内毒素休克时体内生物喋呤的合成与释放 ,明显减轻全身血流动力学障碍。     

己酮可可碱在肾脏疾病中的抗纤维化作用

己酮可可碱是一种非特异的磷酸二酯酶抑制剂，早先针对其调节血流动力学特性，主要用于血管性疾病治疗。近来研究发现，己酮可可碱还是一种有效的抗纤维化制剂。本文就己酮可可碱在肾脏疾病中的抗纤维化作用作一综述。     

经颅高压电烧伤对大鼠肠系膜微血管白细胞流变行为的影响及乌司他丁干预作用

目的 了解经颅高压电烧伤对大鼠肠系膜微血管内白细胞流变行为的影响,以及乌司他丁(UTI)对其的干预作用.方法 将45只SD大鼠按随机数字表法分为假伤组、电伤组和治疗组,每组15只.电伤组和治疗组大鼠均用调压器及实验变压器制成高压电烧伤模型;假伤组大鼠接相同装置但不通电,致假伤.假伤组和电伤组伤后2 min内腹腔注射生理盐水2 mL,治疗组于伤后2 min内按2×104 U/kg腹腔注射UTI 2 mL.用布氏显微镜及微循环图像分析系统观测3组大鼠伤前15 min及伤后5 min、lh、2h、4h、8h肠系膜微血管内滚动白细胞数、白细胞滚动速度、白细胞黏附数、白细胞-内皮细胞接触时间(TLECT).对实验数据行t检验.结果 (1)微静脉滚动白细胞数:电伤组和治疗组大鼠伤后各时相点滚动白细胞数较伤前增多,伤后5 min分别剧增至(51.4±3 2)、(24.6±1 9)个/min,多于假伤组的(1 1±0 7)个/min(t值分别为59 28、44.99,P值均小于0.05);治疗组伤后各时相点滚动白细胞数均少于电伤组,伤后5 min组间比较,t=27.97,P ＜0.05.(2)微静脉白细胞滚动速度:电伤组和治疗组伤后各时相点白细胞滚动速度较伤前下降,伤后5 min最慢,分别为(90±9)、(175±13) μm/s,均慢于假伤组的(277±12) μm/s(t值分别为47 97、21.59,P值均小于0 05);治疗组伤后各时相点白细胞滚动速度均快于电伤组,伤后5 min组间比较,t=20.55,P＜0 05.(3)微静脉白细胞黏附数:电伤组和治疗组伤后各时相点白细胞黏附数较伤前增多,伤后5 min即达每100微米血管(23.27±3.20)、(5.80±1.61)个,均多于假伤组的每100微米血管0个(t值分别为28.16、13 95,P值均小于0.05);治疗组伤后各时相点白细胞黏附数少于电伤组,伤后5 min组间比较,t=18.89,P＜0.05.(4)微静脉TLECT:电伤组和治疗组伤后各时相点TLECT较伤前增高,伤后5 min即达(14.45±1.99)、( 3.66±0 96) s/min,均多于假伤组的0 s/min(t值分别为28.12、14 77,P值均小于0 05),治疗组伤后各时相点TLECT低于电伤组,伤后5 min组间比较,t=18.91,P＜0.05.(5)3组大鼠伤前及伤后微动脉、毛细血管血流中,均未见白细胞滚动或者贴壁黏附.结论 经颅高压电烧伤可导致大鼠肠系膜微静脉白细胞流变行为异常,UTI对此有明显改善作用.     

Microvessels of bulbar conjunctiva in UPTAH goats

Aiming to observe directly the microcirculation after total artificial heart (TAH) implantation, we performed a long-term follow-up in 2 goats using conjunctival angioscopy. A short segment of parallel arteriole and venule was photographed and analyzed on computer picture program (magnification 40x). Three main parameters were measured: arteriole diameter, venule diameter, and arteriovenous ratio (A/V ratio). The intrathoracically implanted TAH was the undulation pump total artificial heart (UPTAH) with cardiac output of 100 ml/kg/min. To stabilize the peripheral hemodynamics a 1/R biofeedback control system was used. Our results provided only elementary data about morphology of bulbar microvessels. The main finding was the tendency to general vasoconstriction, more intensive on the venous side (*P < 0.05 in one goat). We did not observe any pathological shapes (e.g., tortuosities, varicosities, or sludge); this result could be attributed to the high effectivity of 1/R control method. These preliminary results should be considered only as an attempt to apply the widely used clinical method of conjunctival angioscopy to the conditions of TAH.     

四肢高压电烧伤创面的早期处理

目的 总结四肢高压电烧伤创面早期治疗的临床经验.方法 选择2003年1月-2010年12月笔者单位收治的四肢高压电烧伤患者54例,其中男50例、女4例,年龄10～56岁;共有97个患肢,其中上肢67个、下肢30个,致伤部位包括腕及前臂、前臂和肘部及上臂、肩腋部、踝足部、小腿、膝周、大腿及腹股沟,共119处.伤后1～10 d手术,创面切开减张,待患者全身情况相对稳定行下述处理.(1)16个肢体(16处受伤部位)行截肢术,其中5个前臂坏死且肘及上臂受损的上肢行前臂截肢(保留肘关节),并用带蒂背阔肌肌皮瓣修复前臂残端、肘部及上臂创面;1个上臂截肢(保留肩关节)后用带蒂背阔肌肌皮瓣修复残端.(2)95处受伤部位及早清创后用各种血运丰富的组织瓣覆盖.其中5个腕部电烧伤创面行桡动脉重建3个、静脉重建1个、桡动脉及静脉重建1个,1处肘部肱动脉损伤病例行血管重建.(3)8处受伤部位行植皮手术进行修复.统计本组患者术后创面愈合情况,并随访.结果 本组16个肢体截肢术后切口均愈合.5个行血管重建的腕部电烧伤创面,手部供血和(或)静脉回流得以恢复;1例肱动脉损伤病例行动脉重建后血运良好,避免了截肢.5处受损部位组织瓣移植术后远端坏死,其中2处去除坏死组织后予以缝合,3处清创后植皮,创面均愈合.组织瓣下感染8处,其中腕部5处、肘部1处、踝足部2处,经掀起皮瓣或断蒂时再扩创缝合,创面愈合.其余组织瓣均愈合良好.8处受损部位行植皮术后,部分坏死2处,经补植皮片后愈合;其余6处直接愈合.37例患者随访6~12个月,皮瓣外形及质地良好.结论 早期行肢体切开减张、清创、血管重建以及采用修复重建外科技术,是治疗四肢高压电烧伤创面并重建肢体功能、减少截肢率的合理选择.

Abstract：

Objective To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs. Methods Fifty-four patients (50 males and 4 females,aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm,forearm-elbow-upper arm,shoulder-axillary region,ankle-foot,lower leg,around the knee,thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients,certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated,among them forearm amputation was performed for 5 upper limbs with necrosis,with preservation of elbow joints,and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps;1 upper limb with upper arm amputated,with preservation of shoulder joint,was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement,in which 3 brachial arteries,1 vein,1 brachial artery and vein were reconstructed in 5 wrist wounds,artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up. Results Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction,abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting,in which 2 wounds healed after removal of necrotic tissue followed by closure with suture,and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds),elbow (1 wound),ankle-foot (2 wounds),and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting,and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months,the skin flaps survived with satisfactory appearance and texture. Conclusions Early extensive compartment release through fasciectomies and escharectomies,early debridement,early vascular grafting,early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.     

腹部联合轴型皮瓣修复腕部环状高压电烧伤创面

目的 探讨腕部环状高压电烧伤创面的修复方法. 方法 2009年1月-2011年12月,笔者单位收治6例腕部环状高压电烧伤患者,清创后采用腹部联合轴型皮瓣修复腕部创面,即用带部分腹直肌的脐旁皮瓣修复腕屈侧创面,其中腹直肌充填腕屈侧腔隙;下腹部皮瓣修复腕背侧创面,术后4～5周断蒂.供瓣区部分直接.拢缝合,部分在前鞘拉拢缝合后植皮修复. 结果 3例皮瓣术后成活良好;2例皮瓣下有液化坏死组织,经扩创愈合;1例皮瓣术后5周断蒂时出现腕部桡动脉栓塞,清创后立即行大隐静脉移植重建桡动脉后创面愈合.随访6个月～1年,患者腕部功能和外形恢复情况较好. 结论 带部分腹直肌的脐旁皮瓣联合下腹部皮瓣是修复腕部环状高压电烧伤创面的一条可行途径.     

Simple flaps for reconstruction of pediatric scalp defects after electrical burn

Objective:To analyze the management of high-voltage electrical burn injury of the scalp in our hospital.Methods:This study involved 10 patients who suffered from high-voltage electrical burn injury of ...