电烧伤创面早期处理的疗效分析

Clinical analysis on early treatment of electric burn wounds

目的探讨电烧伤创面早期处理的临床效果。方法对2005年1月至2011年12月我院收治的32例电烧伤患者的临床资料进行回顾性分析。4侧肢体创面行切开减张术,17处行截肢(指)术,23处创面行缝合术,34处创面换药治疗。结果23处创面行皮瓣修复,愈合优、良、差者分别为14处、5处、4处。67处创面行皮片修复,愈合优、良、差者分别为44处、13处、10处。一期修复组皮瓣修复16处,皮片修复43处,延期修复组皮瓣修复7处,皮片修复24处。高压电组皮瓣修复16处,皮片修复53处,低压电组皮瓣修复7处,皮片修复14处。延期修复组皮片愈合明显优于一期修复组(P<0.01),其余组间均无统计学差异。结论清创术后合理选择皮片或皮瓣修复创面是取得电烧伤治疗成功的重要环节;皮片修复宜采用延期修复,皮瓣修复宜采用一期修复;DR脱细胞异种皮覆盖、VSD可为创面植皮创造条件。

Objective To summarize the experience of early treatment of electric burn wounds.Methods The clinical data of 32 patients with electric burn who treated in our hospital from January 2005 to December 2011 were analyzed retrospectively.Urgent escharotomy were processed on 4 limbs.17 limbs（fingers） were amputated.23 burn wounds were sutured.34 burn wounds healed with dressing changing.Results 23 flaps of different types were transplanted and the outcome was excellent in 14 flaps,good in 5 flaps,fair in 4 flaps.67 wounds were treated with free skin grafting and the outcome was excellent in 44 wounds,good in 13 wounds,fair in 10 wounds.16 wounds were covered with flaps and 43 wounds were covered with skin grafting in primary repair group.7 wounds were covered with flaps and 24 wounds were covered with skin grafting in delay repair group.16 wounds were covered with flaps and 53 wounds were covered with skin grafting in high-voltage electric burn group.7 wounds were covered with flaps and 14 wounds were covered with skin grafting in low-voltage electric burn group.Skin healing in delay repair group was better than that in primary repair group（P0.01）.The flap healing was no statistical difference between 2 groups.Conclusion Early debridement and appropriate skin choice or flaps grafting coverage wounds are key points for good therapeutic effect in electrical burns.It could achieve better healing for skin grafting on delayed repair wounds,while flap grafting on primary repair wounds.DR acellular xeno-dermis and VSD could create a good condition for skin grafting.