肌皮瓣在肩部深度电烧伤创面修复中应用

Repair of shoulder wounds with myocutaneous flaps in patients after high-voltage electrical burn

目的探讨肌皮瓣修复肩部高压电烧伤创面的治疗效果。方法选取自2009年1月至2015年3月北京积水潭医院烧伤科收治的15例肩部高压电烧伤患者为研究对象。所有肩部创面清创后均采用肌皮瓣修复,10例患者创面应用背阔肌肌皮瓣修复,5例患者创面应用斜方肌肌皮瓣修复,供瓣区直接拉拢缝合。观察患者术后肌皮瓣成活、供区修复情况以及肩部外观、活动情况。结果本组15例患者术后皮瓣均完全成活,供区愈合良好。所有患者均获得3~12个月的随访,肩部皮瓣平整、不臃肿,外观良好,肩关节功能恢复良好,供瓣区留有条状瘢痕。下斜方肌肌皮瓣无翼状或下垂肩胛畸形。结论背阔肌肌皮瓣和斜方肌肌皮瓣是修复肩部高压电烧伤创面的良好的方法。背阔肌肌皮瓣还能够进行三角肌重建,最大程度地恢复肩关节功能。

Objective To investigate the treatment of deep wounds of shoulder using myocutaneous flaps after high-vohage electrical burn. Methods A retrospective study was performed on 15 cases of patients with deep burn wound of shoulder after high-voltage elec- trical burn form January 2009 to March 2015. All wounds of patients were repaired with mycutaneous flaps after debridement,including 10 cases were repaired with latissimus dorsi myocutaneous flaps and 5 cases were repaired with inferior trapezius myoeutaneous flaps. All the donor sites were sutured directly. Survial of flaps and healings of donor sites were observed. The appearance and function recov- ery of shoulder were followed up. Results The postoperative myocutaueous flaps of 15 patients were fully alive, and the donor area healed well. All patients were followed up for 3 to 12 months, the shoulder flaps were smooth and not swollen, the appearance was good, the shoulder joint function was well restored, and the flap area was left with a strip scar. The inferior trapezius myocutaneous flap had no pterygoid or drooping scapular deformity. Conclusion Latissimus dorsi myocutaneous flaps and inferior trapezius myoeutane- ous flaps are good choices for repairing deep burn wound of shoulder after high-voltage electrical burn. The latissimus dorsi musculoeu- taneous flao can also verform deltoid muscle reconstruction to maximize the function of shoulder joint.