足踝部高压电烧伤的手术治疗

Surgical treatment of high voltage electric burn of foot and ankle

目的探讨足踝部高压电烧伤创面的治疗时机及手术方式。方法选取2016年10月至2018年12月,甘肃省人民医院收治的高压电烧伤伴有足踝部损伤患者13例。3例早期进行创面焦痂切开减张术,2例患者于伤后一周左右行小腿中段截肢术;11例患者12个足踝部创面进行多次清创VSD装置或生物敷料覆盖,后期行小腿皮瓣修复术。结果2例截肢患者残端伤口愈合良好;11例患者足踝部电击伤创面皮瓣修复均成活良好,踝关节外形与功能良好。结论创面焦痂切开减张术,可有效防止肢体肿胀引发的组织继发性坏死。电击伤创面负压封闭引流技术或生物敷料的应用仍然只是有限的辅助措施,创面尽早应用血运丰富的组织瓣进行覆盖修复,是保证踝关节功能与外形的最佳方案。

Objective To investigate the timing and surgical methods of high-voltage electric burn wounds in the ankle.Methods From October 2016 to December 2018,13 patients with high voltage electric burn with ankle injury in the People’s Hospital Cansu were selected.Three cases of early wound eschar incision for surgery to reduce tension,two patients underwent amputation of the lower leg in a week or so after the injury;11 patients with 12 ankle and foot wounds were covered with multiple debridement VSD devices or biological dressings,and the lower leg flaps were repaired.Results Two cases of amputated patients with good wound healing;11 patients with foot and ankle electrical burn wound flaps survived well,and the shape and function of the ankle were good.Conclusions Wound escharectomy can effectively prevent secondary necrosis of tissue caused by limb swelling.The use of NPWT or biological dressings requires effective debridement treatment.Early application of blood-rich tissue flaps for wound repair is still the best solution to ensure the function and shape of the ankle joint.