特重度腕部高压电烧伤治疗的改进

目的 减少特重度腕部电烧伤截肢率。方法 将1980年1月至1998年3月的180例216个上肢腕部高压电烧伤分为两个时期进行比较分析，病例按其伤情分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四型，由于认识上的提高和全身治疗及创面修复方法上的改进，如早期综合用药预防血管栓塞，积极的血管重建和使用大网膜和皮瓣早期修复创面等。将两组各型腕部电烧伤治疗措施和最终的截肢率进行比较。结果 1980－1989年及1989－1998年两个时期轻、中度腕部电烧伤（Ⅰ、Ⅱ型）截肢率保持为零，特重度腕部电烧伤截肢率由前一时期的80％降至后一时间的38．9％。结论 重建腕部血管通道、手术修复创面及综合治疗是减少特重度腕部电烧伤截肢率的有效方法。

Management of destructive electrical burns of wrist]

OBJECTIVE: To reduce amputation rate of most severe pattern (Type III) of electrical burns of wrist. METHODS: Early wrist decompression followed by selective transfusion of dextran, PGE1, low molecule heparin to prevent thrombosis of injured radial and ulnar arteries, vascular bridging across the distal forearm and wrist to the hand soon after the appearance of circulatory failure to the hand. Free tissue transfer, especially the use of greater omentum and the innovated abdominal flaps, to repair the circumferential wounds of the wrists are recommended. RESULTS: A group of 102 limbs of 90 patients were treated in the last 10 years, among them the amputation rate of most severe pattern (Type III) of electrical burns of wrists was significantly reduced from 80% to 38.9% compared with 10 years before. CONCLUSION: A comprehensive treatment including the use of anticoagulation drugs, vascular reconstruction, sophisticated surgical repair of the wound are effective in reducing the amputation rate of electrical burns of wrists.