皮瓣修复四肢深度电烧伤创面的临床观察

目的探讨四肢深度电烧伤创面处理的最佳手术时机及手术方式。方法回顾性分析32例共48个四肢深度电烧伤创面的修复。在病情稳定后尽早手术清创，清除坏死组织，保留有活力的间生态组织，即刻采用皮瓣修复。结果48个接受治疗的创面，包括轴型皮瓣修复26处，随意皮瓣修复8处，肌皮瓣修复8处，游离皮瓣修复4处，交肢皮瓣修复2处。其中1例游离皮瓣由于基底感染血管栓塞而发生坏死，待肉芽组织生长后游离植皮修复。其余创面一期修复成功，较好地保存了患肢功能。结论四肢深度电烧伤创面应尽早手术清创，一期修复创面，酌情选择轴型皮瓣、随意皮瓣、肌皮瓣，必要时可选用游离皮瓣或交肢皮瓣，最大限度地保存患肢功能，降低伤残率。

Clinical effect of repairing deep electric burn wounds in limb with skin flaps

Objective To explore the best timing for operation and efficient surgical method to repairing wounds of electric burn in limb. Methods Repairing process of 48 limbs in 32 eases, with deep electric burn wounds were retrosoectively analyze. The surgical debridement had been taken if the patient was in a stable condition, the necrotic tissue had been removed, the vitality parabiosis tissue had been kept, and the wound had been immediately covered by tissue flap providing nice blood irrigation. Results Amount to 48 wounds were treated with flap in this series that included 26 axial skin flaps; 8 random skin flaps; 8 muscle pedicled skin flaps; 4 free skin flaps and 2 cross-limb skin flaps. All of 48 wounds were repaired successfully in one stage and limb function was well preserved, except one case of free skin flap which necrosed due to blood clots from bed infection, and was repaired with grafting skin after granulation grow up. Conclusions In order to preserve wounded limb function and reduce disability as much as possible, authors believed the debridement surgery for deep electric burn wound in limbs ought to be taken as soon as possible, then the wound might be repaired with tissue flap, such as axial skin flap, random skin flap, muscle skin flap according to the patients characteristics, otherwise, free skin flaps or cross-limb skin flaps might be used, if necessary.