腹部联合轴型皮瓣修复腕部环状高压电烧伤创面

Repair of circumferential wound in the wrist region due to high-voltage electrical burn using com- bined abdominal axial pattern flaps

目的探讨腕部环状高难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。供瓣区部分直接拉拢缝合，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。

Objective To explore the method for repairing circumferential wound in the wrist region due to high-voltage electrical burn. Methods Six patients with circumferential wound in the wrist region after high-vohage electrical burn were admitted to our hospital from January 2009 to December 2011. After debridemeul, wounds in the wrist were repaired with combined abdominal axial pattern flaps. The wound of wrist on the flexor aspect was repaired with paraumbilical flap carrying a portion of rectus abdominis that filled the wound cavity of the wrist on the flexor aspect. The wound of wrist on the dorsal aspect was repaired with lower abdominal flap. Pedicle division was performed 4-5 weeks post surgery. Some donor sites were su- tured directly, and the nthers were closed by skin grafting after the suture of anterior sheath. Results Three flaps survived. Liquefaction necrosis of tissue was observed under two flaps, anti they were healed af- ter debridement. Radial artery embolism of wrist oceurred in one flap when pedicle division was performed 5 weeks post surgery, and it was healed by a transplantation of a segment of lhe great saphenous vein to re- construct radial artery right after debridement. Patients were followed up for 6-12 mouths, and satisfactory appearance and function of the flaps were observed. Conclusions It is a feasible option to repair circum- ferential wound in the wrist region due to high-vnhage electrical burn by using paraumbilical flap carrying a portiere of rectus abdominis muscle combined with lower abdominal flap.