Flow-through旋股外侧动脉降支穿支皮瓣在上肢高压电击伤保肢治疗中的应用

Application of the Flow-through flap of descending branch of lateral circumflex femoral artery in the limb salvage treatment of high-voltage electrical injury of the upper extremity

目的探讨Flow-through旋股外侧动脉降支穿支皮瓣对上肢高压电击伤的保肢效果。方法回顾性分析2017年7月至2019年2月笔者单位收治的5例上肢高压电击伤患者,患肢均存在广泛的软组织坏死伴血循环障碍,急诊予以患肢切开减张、坏死组织清除、血管探查及游离Flow-through旋股外侧动脉降支穿支皮瓣移植修复创面并重建肢体远端血运。彻底清创后创面面积6.0cm×4.0cm~17.1 cm×10.3cm,切取皮瓣面积为7.2cm×5.0cm~18.3cm×11.5cm。供区均Ⅰ期闭合。结果1例患者术后7d发生皮瓣下感染,经扩创缝合后顺利愈合;其余患者皮瓣存活良好,创面I期愈合。所有患者获随访6~18个月,平均12个月,保肢成功,皮瓣质地柔软、外形满意,患肢尺、桡动脉通畅,手、腕部血运良好,功能有一定恢复。供区残余片状瘢痕,小范围感觉麻木。结论Flow-through旋股外侧动脉降支穿支皮瓣可及时有效重建肢体血运的同时修复创面,是上肢高压电击伤保肢的理想方法之一,值得推广。

Objective To explore the limb salvage effect of Flow-through flap of descending branch of lateral femoral circumflex artery in the treatment of high-voltage electrical injury of the upper extremity.Methods From July 2017 to February 2019,five patients with high-voltage electrical injury of upper extremity were analyzed retrospectively.Extensive soft tissue necrosis and blood circulation disorder were found in all of the affected limbs.Emergency treatment including incision and decompression of the affected limb,removal of necrotic tissue,vascular exploration,transplantation of Flow-through flap of descending branch of lateral circumflex femoral artery were implemented to repair the wound and reconstruct the distal blood circulation of the limb.The wound area after thorough debridement ranged from 6.0 cm×4.0 cm to 17.1 cm×10.3 cm,and the flap area ranged from 7.2 cm×5.0 cm to 18.3 cm×11.5 cm.The donor area was closed directly in one stage.Results One patient developed subflap infection 7 days after operation and healed successfully after debridement and suturing.The other flaps survived well and healed in stage I.All patients were followed up for 6 to 18 months,with an average of 12 months.All the patients were successful in limb preservation,the skin flap was soft and satisfactory in shape,the ulnar and radial arteries of the affected limb were unobstructed,the blood supply of the hand and wrist was good,and the function was restored to a certain extent.There were lamellar scars in the donor region with only a small area of numbness.Conclusions The Flow-through flap of the descending branch of the lateral circumflex femoral artery can effectively reconstruct the blood supply of the limbs and repair the wounds at the same time,which is one of the ideal methods for limb salvage treatment in the high-voltage electrical injury of upper extremity.