旁路静脉桥接在游离股前外侧皮瓣修复头部高压电烧伤创面中的临床应用效果

Clinical application effect of bypass vein bridging in repairing high-voltage electric burn wounds on the head with free anterolateral thigh flaps

目的探讨旁路静脉桥接在游离股前外侧皮瓣修复头部高压电烧伤创面中的临床应用效果。方法该研究为回顾性观察性研究。2017年5月—2022年12月,郑州市第一人民医院收治8例符合入选标准的头部高压电烧伤患者,其中男6例、女2例,年龄33~73岁,均有颅骨外露,其中3例患者颅骨大面积缺损,1例患者左眼坏死,3例患者脑出血。清创后头部创面面积为13 cm×7 cm~21 cm×15 cm,切取面积为14 cm×8 cm~22 cm×16 cm的游离股前外侧皮瓣进行修复。将皮瓣携带的旋股外侧动脉降支主干与受区颞浅动脉端端吻合;将皮瓣吻合动脉的一条伴行静脉通过桥接大隐静脉与颈外静脉属支端端吻合,另一条伴行静脉与受区颞浅静脉端端吻合。将供区创面直接拉拢缝合或移植大腿内侧中厚皮片封闭。术后观察皮瓣血运、成活情况和头部创面愈合情况,记录术后2周内应用彩色超声诊断系统观察到的移植静脉血管血流情况及管腔充盈情况,记录皮瓣供区创面修复方式并观察皮瓣供区创面愈合情况。随访观察皮瓣及其供区的外观、皮瓣供区所在下肢肌力,以及患者能否用皮瓣供区所在下肢完成站立、行走及下蹲。结果术后8例患者皮瓣均成活,均未发生动脉危象或静脉危象;5例患者头部创面术后愈合,3例患者头部创面因术后2周皮瓣下方有分泌物渗出于术后21~35 d再次行清创术后愈合。术后2周内,移植静脉血管持续通畅,超声探头加压后移植静脉可被压瘪,松开探头后血管迅速充盈。3例患者皮瓣供区创面被直接拉拢缝合,术后2周愈合;5例患者皮瓣供区创面为移植大腿内侧中厚皮片封闭,术后12 d皮片全部成活。随访6~12个月,所有患者头部皮瓣轻度臃肿,无毛发生长;供区遗留轻度线性或片状瘢痕增生,所有皮瓣供区所在下肢肌力正常、无减退,患者能用皮瓣供区所在下肢完成站立、行走及下蹲。结论在应用游离股前外侧皮瓣修复各种面积、深度的头部高压电烧伤创面时进行旁路静脉桥接,可减少术后皮瓣静脉危象的发生,术后创面愈合质量高,皮瓣供区所在下肢功能不受影响。

Objective To investigate the clinical application effect of bypass vein bridging in repairing high-voltage electric burn wounds on the head with free anterolateral thigh flaps.Methods This study was a retrospective observational study.From May 2017 to December 2022,8 patients with high-voltage electric burns on the head who met the inclusion criteria were admitted to Zhengzhou First People's Hospital,including 6 males and 2 females,aged 33 to 73 years.All patients had skull exposure,including 3 cases of large skull defect,1 case of left eye necrosis,and 3 cases of cerebral hemorrhage.After debridement,the head wound area was from 13 cm×7 cm to 21 cm×15 cm,and the free anterolateral thigh flap with the area of 14 cm×8 cm to 22 cm×16 cm was cut for repair.The main descending branch of the lateral circumflex femoral artery carried by the flap was anastomosed end-to-end with the superficial temporal artery in the recipient area.One accompanying vein of the anastomotic artery of the flap was end-to-end anastomosed with the branch of the external jugular vein via great saphenous vein bridging,and the other accompanying vein was end-to-end anastomosed with the superficial temporal vein in the recipient area.The donor site wounds were directly sutured or closed with medium-thickness skin grafts from inner thigh.The blood supply and survival of the flap,and the wound healing on the head were observed after operation.The blood flow and lumen filling of the transplanted vein were observed and recorded by using color ultrasound diagnostic system within 2 weeks after operation.The wound repair method and wound healing of the flap donor site were recorded and observed.Patients were followed up to observe the appearance of the flaps and the flap donor sites,the muscle strength of the lower limbs where the flap donor site was located,and whether the patient could complete standing,walking,and squatting using the lower limbs where the flap donor site was located.Results The flaps of 8 patients survived after operation,and no arterial or venous crisis occurred.The wounds of 5 patients on the head healed after operation,and the wounds of 3 patients on the head healed after second debridement 21 to 35 days after operation due to exudates under the flap 2 weeks after operation.Within 2 weeks after operation,the grafted vein continued to be unobstructed.After the ultrasound probe was pressurized,the grafted vein could be deflated,and the blood vessels were rapidly filled after the probe was released.The wounds of flap donor sites of 3 patients were directly sutured and healed 2 weeks after operation.The wounds of flap donor sites of 5 patients were closed with medium-thickness skin grafts from inner thigh,and all the skin grafts survived 12 days after operation.During follow-up of 6 to 12 months,the head flaps of all patients were slightly bloated without hair growth.Mild linear or patchy scar hyperplasia was left in the donor site.The muscle strength of the lower limbs where the flap donor site was located was normal and did not decrease.The patients could stand,walk,and squat with the lower limbs where the flap donor site was located.Conclusions When using the free anterolateral thigh flap to repair high-voltage electric burn wounds of various areas and depths on the head,bypass vein bridging can reduce the occurrence of postoperative flap vein crisis and improve the quality of postoperative wound healing without affecting the function of the lower limbs where the flap donor site is located.