上肢热压伤合并主干血管损伤的治疗

目的探寻肢体热压伤合并主干血管损伤的治疗方案。方法对8例上肢严重热压伤合并骨筋膜室综合征患者实施减压术，但对肢体血运的改善不明显。行血管探查得知患肢均合并肱、桡、尺动脉或掌深、浅弓损伤，采用直接吻合、屈曲肢体吻合、大隐静脉移植等方式修复血管并移植中厚皮片或带蒂胸脐皮瓣封闭创面。结果l例肱动脉修复后创面植中厚皮片者因无良好的软组织覆盖，术后4周血管再度栓塞导致上臂中段截肢。7例血管修复后创面移植皮瓣的患者肢体血供完全恢复并得以完整保留。结论及时行血管探查和修复以及选择周围良好的软组织覆盖，是治疗热压伤合并主干血管损伤的关键措施。

Management of hot press injury complicating with blood vessel injury in the upper extremity

Objective To explore the therapeutic strategy of hot press injury complicating with blood vessel injury in the upper extremity. Methods Decompression procedure was carried out in 8 patients with hot press injury complicating with blood vessel injury in the upper extremities, but the effect was not of satis- factory because there were injuries to brachial, radial and ulnar arteries and also injury to the superficial or deep palmar arch. The blood vessels were repaired with direct anastomosis , anastomosis with flexion of the limb, or transplantation with great saphenous vein, and the wounds were covered with intermediate splitthickness skin graft or pedicled thoraco-abdominal skin flap. Results One patient with repair of the bra- chial artery and intermediate split thickness skin graft received amputation 4 weeks after operation because of lack of soft tissue coverage. The blood supply recovered completely in the other patients, so the affected limbs were saved. Conclusion Prompt exploration and repair of blood vessel, and coverage of the wound with healthy soft tissue are key procedures for the management of hot press injury complicating with blood vessel injury in the upper extremities.