海水浸泡感染后皮肤软组织缺损修复的差异性观察Δ

[目的]观察海水浸泡感染后人工材料置入皮肤软组织缺损的修复研究。[方法]取狗左右桡骨中段截骨制成开放性皮肤软组织及骨缺损动物模型,随机分成二组,实验组海水浸泡伤口2 h,对照组开放伤口自然暴露2 h,感染后3 d分别给予伤口清创并置入人工骨,每组各12只,创面共24例,并以玻璃纤维石膏绷带固定,术后12周观察各组动物皮肤、软组织愈合及材料移动情况,并行统计学分析。[结果]a:术后12周实验组皮肤及软组织愈合差于对照组,P<0.05,有统计学意义;b:术后12周实验组与对照组材料移动情况无明显差别,P>0.05,无统计学意义。[结论]海水浸泡感染后动物皮肤及软组织愈合差于自然暴露感染动物,海水浸泡与自然暴露材料稳定性一样差。     

几丁糖/海藻酸敷料对海水浸泡创面作用的实验研究

目的 观察几丁糖(chitosan,CTS)/海藻酸(alginate,ALG)敷料对大鼠海水浸泡创面的作用.方法 取健康SD大鼠25只,体重250～300 g,于脊柱两侧切取直径1.8 cm圆形创面,制作皮肤创面模型,左侧为实验组,右侧为对照组.将创面浸泡于预先配置的人工海水1 h后,实验组采用CTS/ALG敷料外敷创面,对照组用无菌纱布外敷.行大体观察并记录创面愈合时间;术后3、5、7、10、12 d切取包括创面在内的2 cm×2 cm皮肤标本,行HE染色和免疫组织化学Envision法染色,观察创面组织学改变及EGF受体(EGF receptor,EGFR)、bFGF表达情况.结果 实验组创面炎性反应轻,结痂收缩较快;对照组创面结痂收缩较慢.实验组创面完全愈合时间为(11.68±0.57)d,对照组为(12.51±0.54)d,比较差异有统计学意义(P＜0.05).实验组自术后3 d开始出现肉芽组织增生及细胞浸润,胶原组织增生,创面皱缩及上皮化,至术后10 d胶原组织已排列整齐,上皮化过程基本完成,可见皮肤附件出现,术后12 d完全愈合;对照组相应时间点细胞浸润出现晚,且出现肉芽组织伴溃疡,上皮化过程较晚.免疫组织化学观察示实验组术后3、5 dbFGF在血管内皮细胞和间质纤维母细胞内高表达,EGFR在血管内皮细胞内高表达,术后7、10、12 d呈低表达;对照组术后相应时间点bFGF及EGFR呈低表达和无表达.结论 CTS/ALG对海水浸泡创面具有促进愈合作用,但其机制仍有待进一步深入研究.     

海水浸泡开放性骨折不同救治方法的实验研究

目的观察两种骨折固定方法救治海水浸泡开放性骨折的大体形态、组织病理学、影像学变化。方法取成年新西兰兔50只，随机分为三组：对照组10只、A组20只、B组20只。于胫骨中段截骨制成开放性骨折动物模型。对照组伤口自然旷置3h，A组和B组海水浸泡伤口3h。随后对照组和A组行伤口清创、钢板螺钉内固定术；B组行伤口清创、外固定架固定、伤口开放换药、二期缝合。观察各组的伤口感染情况、骨折愈合的组织学、影像学变化和测定骨折断端骨痂的平均比灰度值。结果a）对照组感染1只（10％），A组感染15只（75％），B组感染5只（25％）。各组间结果有统计学差异（P〈0．05）。b）术岳45d时各组间骨折断端组织愈合等级有统计学差异（P〈0．05）。c）术后45d时各组间骨折部位骨痂的生长情况在影像学上表现为对照组大于B组大于A组。各组间骨愈合率对照组为100％，A组为66．7％，B组为93．3％。d）术后45d时骨折断端间骨痂的平均比灰度值对照组为8．1149±1．2043，A组为6．2268±1．4000，B组为6．5138±1．3045，各组间有统计学差异（P〈0．05）。结论海水浸泡使开放性骨折伤口感染率增高；海水浸泡使开放性骨折断端骨痂形成不良率增高；骨外固定架与钢板内固定比较救治成功率提高。     

海水浸泡股骨开放性骨折的早期救治

目的利用犬动物模型研究海水浸泡股骨开放性骨折的伤情特点及早期救治方法。方法20只华北成年犬,随机分为对照与海水浸泡两组。于股骨中段截骨制备开放性骨折的动物模型,实验组犬浸泡于海水中3h,对照组于笼内放置3h,两组均于3h后行伤口清创、钢板螺钉内固定术。结果①对照组和海水浸泡组分别有1只和3只动物伤口感染(P>0.05);②病理结果显示海水浸泡组软骨骨痂较多;③生物力学测试两组骨愈合刚度分别为(451.49±183.00)N和(150.15±20.16)N(P<0.05);④影像学观察两组骨痂形成及骨愈合无明显差别。结论①海水浸泡使开放骨折感染率有增高趋势。②海水浸泡使骨折愈合质量下降,骨折愈合过程有延迟倾向。③生物力学测定示海水浸泡开放骨折愈合强度明显低于对照组。④内固定有增加伤口感染的风险,但在股骨这一特定部位可选择性应用。     

海水浸泡开放性骨折伤愈合过程中组织病理学和血管内皮细胞生长因子(VEGF)表达

目的通过观察普通开放骨折、海水浸泡开放骨折愈合过程的组织学变化和骨痂中血管内皮细胞生长因子(VEGF)的表达,了解海水浸泡开放性骨折愈合过程VEGF的作用与机制。方法新西兰大白兔59只,随机分为普通开放骨折组(对照组)24只和海水浸泡开放骨折组(实验组)35只。造成桡骨横行1.5mm缺损完全开放骨折,普通开放骨折伤组旷置3h,海水浸泡开放骨折伤组海水浸泡伤口3h,之后依次缝合伤口。于第1、3、7、14、21、28、45天处死动物。观察海水浸泡开放骨折伤在骨折愈合中不同时间的病理过程。采用RT-PCR方法检测普通开放骨折、海水浸泡开放骨折不同阶段骨痂中的VEGF的表达及变化。结果海水浸泡开放骨折伤骨痂形成延迟,骨折后第28天,对照组断端间骨痂为骨性骨痂者8例,为软骨者4例,实验组断端间骨痂为骨性骨痂者6例,为软骨者14例。海水浸泡骨折伤愈合过程中新生骨痂的VEGF表达在骨折后逐渐升高,术后14d达到高峰,之后逐渐下降,但在28d时仍保持较高水平,与一般开放骨折愈合过程的VEGF表达无显著差异(P>0.05)。结论海水浸泡使骨折骨痂形成不良率增高,骨折愈合过程有延迟倾向;但骨折愈合过程中VEGF表达无明显变化。     

蛆虫分泌物对糖尿病大鼠溃疡组织bFGF和结缔组织生长因子表达的影响及抗茵作用研究

目的 探讨蛆虫分泌物对糖尿病(diabetes mellitus,DM)大鼠溃疡组织bFGF和结缔组织生长因子(connective tissue growth factor,CTGF)表达的影响及预防细菌感染的作用.方法 取3月龄雄性SD大鼠40只,体重300～350 g,制备DM大鼠溃疡创面模型.随机分为2组(n=20),实验组创面涂以丝光绿蝇蛆虫的分泌物,对照组不予处理.术后1～21 d观察创面大体情况,7、14、21 d分别记录两组溃疡面积;术后14 d取两组溃疡组织,制备组织切片,行HE染色观察;3、7、14 d取溃疡表面分泌物行常规细菌培养,检测细菌感染情况;术后7、14、21 d用免疫组织化学法处理切片,显微镜下对bFGF、CTGF阳性表达细胞进行计数分析.结果 实验组创面清洁,新鲜肉芽生长,无脓性分泌物,愈合情况良好,无金色葡萄球菌感染;对照组创面渗出、糜烂严重,创面不断加大加深,愈合情况不良,金色葡萄球菌感染率为60%.术后7、14、21 d实验组溃疡面积分别为(1.83±0.23)、(0.39±0.08)cm2和0,对照组分别为(2.18±0.67)、(3.57±0.53)、(3.94±0.67)cm2;两组比较差异均有统计学意义(P＜0.05).14 d组织学观察示实验组上皮组织新生,创缘炎性坏死物减少,纤维瘢痕形成;对照组大量炎性细胞浸润,坏死组织较多.术后7、14 d,实验组bFGF阳性表达数分别为23.76±3.34、52.76±4.84,对照组为18.88±2.16、46.04±4.00;实验组CTGF阳性表达数分别为18.76±3.24、46.52±4.07,对照组为12.52±3.03、40.52±3.96;两组比较差异均有统计学意义(P＜0.05)21 d,两组bFGF及CTGF阳性表达数差异无统计学意义(P＞0.05).结论 蛆虫分泌物能提高DM溃疡组织bFGF、CTGF的表达,有效促进创面愈合,预防组织细菌感染.     

海水浸泡对烫伤大鼠创面炎性反应与愈合的影响

目的观察海水浸泡对烫伤大鼠创面炎性反应及愈合的影响。方法将144只雄性Wistar大鼠随机分为烫伤对照组和海水浸泡组,每组72只,均造成背部10%TBSA浅Ⅱ度烫伤。海水浸泡组大鼠伤后固定四肢,立即用盛海水的方盆浸泡双前肢以下部分,持续4h；烫伤对照组大鼠则用空方盆模拟浸泡过程。于伤后0(即刻,下同)、6、12、24h采用电解质分析仪测定血清中K~+、Na~+、Cl~-的浓度。于伤前及伤后0、6、12h采用酶联免疫吸附测定法检测血清中肿瘤坏死因子(TNF)α及白细胞介索(IL)6的含量。对两组大鼠创面行大体和组织病理学观察,并记录创面愈合时间。结果海水浸泡组大鼠血清中K~+、Na~+、Cl~-的浓度大多高于烫伤对照组。伤后6h海水浸泡组大鼠血清TNF-α、IL-6含量分别为(140±22)、(160±41)ng/L,均明显高于伤前值(29±15)、(62±17)ng/L及烫伤对照组(120±12)、(124±22)ng/L(P＜0．05)。与烫伤对照组比较,海水浸泡组大鼠创面水肿及局部组织炎性反应加重,创面再上皮化和表皮各层的分化延迟；海水浸泡组创面愈合时间为(16．3±1．6)d,明显迟于烫伤对照组(14．1±1．8)d(P＜0．05)。结论大鼠烫伤后经海水浸泡,可加重创面炎性反应,使创面愈合延迟。     

犬开放性气胸海水浸泡早期死亡原因探

目的 建立犬开放性气胸海水浸泡的实验模型,探讨实验动物早期死亡原因. 方法 20条健康成年杂种犬随机分为两组.对照组:实验动物受伤后直接观察;实验组:动物受伤后置入人工配制的海水中.监测血流动力学、呼吸、血液渗透压、血液电解质、动脉血气变化以及肺部病理改变. 结果 实验组死亡率明显高于对照组,平均生存时间为45分钟.实验组经海水浸泡后有急性呼吸和循环功能衰竭、严重电解质平衡紊乱、高渗血症、重度肺损伤以及严重代谢性和呼吸性酸中毒. 结论 开放性气胸后海水浸泡可引起一系列严重的病理生理变化,其结果是导致实验动物早期死亡的重要原因.     

海岸及海水中肢体关节爆炸伤的实验研究

[目的]建立海岸及海水中兔肢体关节爆炸模型,观察爆炸伤的组织学改变。[方法]健康家兔112只,随机分为预实验组(A组,n=36),分别以0.3、0.6、0.9、1.2 g单质猛炸药黑索金(RDX)铜壳小型爆炸装药捆绑于兔膝关节前外侧,电引爆,测量比较肢体关节炸伤情况;海岸实验组(B组,n=56),0.9 g RDX铜壳小型爆炸装药引爆,伤口包扎后浸入海水中1 h;海水中实验组(C组,n=20),0.9 g RDX铜壳小型爆炸装药捆绑于兔膝关节前外侧,浸入海水中、电引爆。B组炸伤后、海水浸泡后及C组炸伤后分别取肌肉、韧带、滑膜、软骨作组织学观察。[结果]A组比较不同装药量爆炸结果,选定0.9 g RDX铜壳小型爆炸装药,海绵间隔6 cm软固定于兔膝关节前外侧爆炸,13只兔造成(5.17±0.42)cm×(4.73±0.41)cm爆炸伤口,铜质爆炸破片侵入伤口内,髌韧带、股骨外髁软骨面不同程度损伤。B组均造成肢体关节开放伤,海水浸泡1 h后组织学观察突出变化是肌肉及滑膜组织水肿、肌肉组织广泛坏死及韧带组织中出现大量Ⅲ型胶原。C组14只兔海水中爆炸,均为肢体关节闭合性爆炸伤,肢体关节高度肿胀,胫股骨多发骨折,爆炸破片深及皮内。组织学观察见肌纤维断裂,肌间血管充血,软骨组织轻度变性,软骨细胞核固缩,核碎裂。[结论]0.9 g RDX铜壳爆炸装药间隔6 cm固定于兔膝关节前外侧,海岸上爆炸在冲击波和爆炸破片共同作用下造成肢体关节开放爆炸伤,海水浸泡1 h加重了组织肿胀,坏死;海水中爆炸,主要为爆炸冲击波的作用,造成肢体关节闭合性爆炸伤,胫股骨多发骨折,软组织损伤、出血更为严重。     

带蒂大网膜修复严重输尿管损伤及其机制的实验研究

目的 探讨带蒂大网膜修复严重输尿管损伤的作用机制. 方法 20只健康成年杂种犬随机分为实验组及对照组,每组10只,均建立严重输尿管损伤动物模型,端端吻合输尿管后实验组采用带蒂大网膜包裹损伤输尿管,对照组未采用大网膜包裹.术后不定期观察有无尿瘘及输尿管坏死.术后12周观察术侧输尿管损伤愈合情况,取吻合口及周围组织行病理学检查,镜下观察血管再生情况,免疫组化检测血管内皮生长因子(VEGF)及其受体KDR的表达. 结果 术后实验组无尿瘘,对照组2只因尿瘘反复腹腔感染死亡.术后12周实验组输尿管吻合口处黏膜及平滑肌层完全再生,血管再生现象明显,VEGF及KDR表达阳性细胞密度分别为(12.65±0.02)%和(10.23±0.03)%.对照组吻合口愈合不良并狭窄,思侧肾严重积液(脓),无明显血管再生,VEGF及KDR表达阳性细胞密度仅为(1.54±0.03)%、(2.65±0.04)%,明显低于实验组(均P<0.05). 结论 带蒂大网膜有促进严重输尿管损伤修复作用,可能通过VEGF及KDR表达升高促进血管再生而实现.     

左氧氟沙星壳聚糖缓释微球对海水浸泡创伤的初期治疗结果

目的:通过动物实验,了解左氧氟沙星壳聚糖微球对早期海水浸泡创伤的初期治疗结果。方法:建立兔软组织海水浸泡伤模型。比较对照组(n=8)和局部应用左氧氟沙星壳聚糖微球组(n=8)于海水浸泡前和浸泡结束后6、12、24、48、72h创伤局部菌落计数、血浆内毒素、局部组织和血浆TNF鄄α浓度。结果:自浸泡后6h起,对照组菌落数量显著高于微球组(P<0.01)。海水浸泡后,两组血浆内毒素水平均呈明显上升趋势;但于浸泡后6h起应用缓释微球组者,血浆内毒素水平显著低于对照组(P<0.01)。在海水浸泡后,两组TNF鄄α均呈明显上升趋势;但自浸泡后6h起,微球组局部组织TNF鄄α浓度显著低于对照组(P<0.05);12h时微球组血浆TNF鄄α浓度显著低于对照组(P<0.01)。结论:海水浸泡伤局部应用缓释制剂者,可发挥控制局部炎症反应、减轻局部伤道组织的继发损伤的作用。     

Effects of depression on healing and inflammatory responses of acute wounds in rats

This study aimed to elucidate the effect of depression on the healing of acute wounds in rats. We hypothesized that depression would have negative effects on inflammation and wound healing and that antidepressant therapy would reverse these effects. This study included 100 rats randomly allocated into five groups: control group (CG), depression group (DG), pre‐depression group (PDG), antidepressant group (AG), and pre‐antidepressant group (PAG). Acute wounds were created on the rats' backs. The groups were subjected to no interventions (CG), aversive stimuli before (PDG) and after (DG) wound creation, and antidepressant treatment before (PAG) and after (AG) wound creation. On the day of wound creation and on days 3, 6, 9, and 12 after wound creation, observations of the wound area and degree of depression (evaluated using the sucrose preference test, open‐field test, and weight change) were recorded. On days 6 and 12 after wound creation, venous serum and wound tissues were collected. Tumor necrosis factor alpha (TNF‐α), interleukin (IL)‐1β, IL‐6, and IL‐10 levels were measured using the enzyme‐linked immunosorbent assay. Results showed an initial increase followed by a decrease in the degree of depression in all groups except DG (continuous decline). The wound‐healing rate was significantly lower in PDG and DG than in CG; it was higher in AG and PAG than in CG. DG and PDG had higher concentrations of inflammatory cytokines than CG, and AG and PAG had lower concentrations than CG. This indicates that the onset of depression delays the healing of acute wounds and aggravates the inflammatory response in rats. Antidepressant treatment counteracts both of these negative effects.     

Transforming growth factor-β levels during second- intention healing are related to the different course of wound contraction in horses and ponies

Wound healing in horses is often complicated by wound infection, exuberant granulation tissue, and hypertrophic scars, especially when wounds are located on the limbs. Wound healing in ponies is less problematic, characterized by a greater degree of wound contraction and a more intense initial inflammatory response. Because both processes are influenced by transforming growth factor-beta (TGF-beta), it was hypothesized that the better wound healing in ponies was associated with different TGF-beta profiles. A series of small wounds was created on the distal limbs and hindquarters of ponies and horses. Tissue samples were harvested on alternate days until day 13 postwounding, and levels of total and active TGF-beta were determined. Levels of TGF-beta were significantly higher in pony wounds than in those of horses. The TGF-beta profile differed between limb and body wounds, with levels in body wounds decreasing at the end of the experiment and persisting in limb wounds. In ponies, the higher TGF-beta levels can, to a large extent, explain the more intense inflammatory response and may explain the greater degree of wound contraction. Apparently adequate levels in the limbs fail to result in greater wound contraction, probably because of a stronger fixation of the skin. The persistence of elevated levels of TGF-beta may result in the production of exuberant granulation tissue. Further research on the temporal patterns of the different TGF-beta isoforms seems indicated, because manipulation of TGF-beta levels appears to be a promising option for intervention in problematic wound healing in horses.     

猪皮肤软组织海水浸泡爆炸伤创面动物模型的建立

目的 建立猪皮肤软组织海水浸泡爆炸伤创面动物模型.方法 选取8头（3头在预实验中死亡,5头进入实验）小型猪作为实验动物,在每头猪的双侧肩胛部、臀部制造4个损伤程度相当的海水浸泡爆炸伤创面,创面累及全层皮肤至脂肪层,肌肉、骨骼无明显损伤.结果 当雷管距皮肤0 cm时,创面较大,出血较多,伴邻近肢体骨折和局部肌肉缺损,于海水浸泡后6h死于全身多脏器损伤合并失血性休克;当雷管距皮肤1.0 cm时,肩胛部创面在范围、深度上均符合要求,但合并肺损伤,该猪于海水浸泡后32 h死于大面积肺梗死;当雷管距皮肤1.5 cm时,肩胛部和臀部的创面在范围、深度上均符合要求,创面可重复性好,但该猪于海水浸泡后10 h死于持续性低体温.立即改变海水浸泡方式,将炸后实验小型猪放置海水中改为海水持续浸泡爆炸创面1h,模型可重复性好,动物存活好.结论 雷管距猪皮肤为1.5 cm时,爆炸创面经海水浸泡1h,创面可重复性好,动物存活好,适合实验研究.     

Embryonic stem cell–derived M2‐like macrophages delay cutaneous wound healing

In adults, repair of deeply injured skin wounds results in the formation of scar tissue, whereas in embryos wounds heal almost scar‐free. Macrophages are important mediators of wound healing and secrete cytokines and tissue remodeling enzymes. In contrast to host defense mediated by inflammatory M1 macrophages, wound healing and tissue repair involve regulatory M2/M2‐like macrophages. Embryonic/fetal macrophages are M2‐like, and this may promote scar‐free wound healing. In the present study, we asked whether atopical application of ex vivo generated, embryonic stem cell–derived macrophages (ESDM) improve wound healing in mice. ESDM were tested side by side with bone marrow–derived macrophages (BMDM). Compared to BMDM, ESDM resembled a less inflammatory and more M2‐like macrophage subtype as indicated by their reduced responsiveness to lipopolysaccharide, reduced expression of Toll‐like receptors, and reduced bacterial phagocytosis. Despite this anti‐inflammatory phenotype in cell culture, ESDM prolonged the healing of deep skin wounds even more than BMDM. Healed wounds had more scar formation compared to wounds receiving BMDM or cell‐free treatment. Our data indicate that atopical application of ex vivo generated macrophages is not a suitable cell therapy of dermal wounds.     

重组人粒细胞/巨噬细胞集落刺激因子联合水凝胶敷料治疗深Ⅱ度烧伤创面临床观察

目的:观察外用重组人粒细胞/巨噬细胞集落刺激因子(rhGM-CSF)联合水凝胶敷料治疗深Ⅱ度烧伤创面的临床效果.方法:选择四肢部位有深Ⅱ度烧伤创面的住院患者24例,48处研究创面,每例患者2个创面,分别位于不同肢体.研究分为4组.随机选取12例患者,每例患者随机选取一个创面作为rhGM-CSF联合外用水凝胶敷料治疗组(联合治疗组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖医用水凝胶敷料),另一个创面作为rhGM-CSF联合外用凡士林油纱治疗组(rhGM-CSF对照组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖凡士林油纱);余12例患者每例随机选择一处创面作为水凝胶敷料治疗组(水凝胶对照组,创面直接覆盖医用水凝胶敷料);另一处创面作为凡士林油纱对照组(凡上林对照组,创面直接覆盖凡士林油纱).每组12处创面.观察各组创面愈合时间及创面感染情况,创面分泌物行细菌培养,比较创面细菌感染阳性率.结果:联合治疗组创面愈合时间较其他3组明显缩短(P＜0.05);rhGM-CSF对照组和水凝胶对照组创面愈合时间较凡士林对照组缩短(P＜0.05).rhGM-CSF联合外用水凝胶敷料治疗组创面洁净,细菌检出率低(16.7％):rhGM-CSF治疗组感染状况也较轻,细菌检出率较低(25.0％),凡士林对照组感染状况重,细菌检出率最高(83.3％,P＜0.01).结论:深Ⅱ度烧伤创面外用rhGM-CSF联合水凝胶敷料治疗,可以明显减少创面细菌感染概率,缩短创面愈合时间.     

碳纤维敷料在烧伤创面中的临床应用

目的观察碳纤维敷料对烧伤创面的治疗作用。方法选择浅Ⅱ°、深Ⅱ°和残余创面共277例,随机分为对照组(碘伏纱布换药)和治疗组(碳纤维敷料换药)。观察敷料吸收容量、创面炎症反应,并做创面细菌定量和创面组织学检查,记录创面愈合时间等。结果与对照组相比,治疗组敷料吸收容量大,创面炎症反应轻,创周炎症消退快,痂下组织细菌定量低。浅Ⅱ°、深Ⅱ°及残余创面愈合时间分别为(7．4±2．1)d、(16．2±2．6)d、(19．4±6．2)d,均较对照组缩短,对照组分别为(9．6±2．4)d、(19．6±3．4)d和(28．8±10．4)d。结论碳纤维敷料是一种具有吸附能力强、可有效控制炎症反应、促进创面愈合等特点的新型敷料。     

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.