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

doi:10.13418/j.issn.1001-165x.2021.06.015

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (6): 707-710.doi: 10.13418/j.issn.1001-165x.2021.06.015

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

薛佳杰，　王耀军，　任忠亮，　郭雷

榆林市第二医院烧伤整形手足外科，陕西榆林 719000

收稿日期:2020-12-31 出版日期:2021-11-25 发布日期:2021-12-01
通讯作者: 王耀军，主任医师，E-mail：doctwyj@163.com
作者简介:薛佳杰（1986-），男，医学硕士，整形外科方向，E-mail：495229077@qq.com
基金资助:
国家自然科学基金青年项目资助（81401593）

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

Xue Jiajie, Wang Yaojun, Ren Zhongliang, Guo Lei

Department of Burns＆Plastic and Hand＆Foot Surgery, Yulin No.2 Hospital, Yulin 719000, Shanxi Province, China

Received:2020-12-31 Online:2021-11-25 Published:2021-12-01

摘要/Abstract

摘要： 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6.0 cm×4.0 cm ~ 17.1 cm×10.3 cm，切取皮瓣面积为7.2 cm×5.0 cm ~ 18.3 cm×11.5 cm。供区均Ⅰ期闭合。结果　1例患者术后7 d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。

关键词: 电击伤, 　Flow-through皮瓣, 　急诊手术, 　保肢, 　显微外科技术

Abstract: 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.

Key words: Electric injury;　Flow-through flap;　Emergency operation;　Limb salvage; , Microsurgery technology

中图分类号:

R628

薛佳杰, 　王耀军, 　任忠亮, 　郭雷. 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[J]. 中国临床解剖学杂志, 2021, 39(6): 707-710.

Xue Jiajie, Wang Yaojun, Ren Zhongliang, Guo Lei. 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[J]. Chinese Journal of Clinical Anatomy, 2021, 39(6): 707-710.

参考文献 20

[1]	蒋梅君, 李泽, 谢卫国, 等. 2133例电烧伤住院患者流行病学调查[J]. 中华烧伤杂志, 2017, 33(12): 732-737. DOI:10.3760/cma.j.issn.1009-2587.2017.12.003.
[2]	孙永华. 我国电烧伤治疗的成就与挑战[J]. 中华烧伤杂志, 2008, 24(5). DOI: 10.3760/cma.j.issn.1009-2587.2008.05.022.
[3]	Kasana RA, Baba PUF, Wani AH. Pattern of high voltage electrical injuries in the Kashmir valley: a 10-year single centre experience[J]. Ann Burns Fire Disasters, 2016, 29(4): 259-263.
[4]	Fan XM, Ma B, Zeng D, et al. Burns in a major burns center in East China from 2005 to 2014: incidence and outcome[J]. Burns, 2017, 43(7): 1586-1595. DOI: 10.1016/j.burns.2017.01.033.
[5]	唐举玉. 特殊形式穿支皮瓣的临床应用教程[J]. 中华显微外科杂志, 2013, 36(2): 201-205. DOI: 10.3760/cma.j.issn.1001-2036.2013.02.038.
[6]	Gencel E, Eser C, Kesiktas E, et al. A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns[J]. Burns, 2016, 42(4): e55-e60. DOI: 10.1016/j.burns.2015.10.014.
[7]	Koshima I, Kawada S, Etoh H, et al. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities[J]. Plast Reconstr Surg, 1995, 95(2): 252-260. DOI: 10.1097/00006534-199502000-00004.
[8]	沈余明, 覃凤均, 杜伟力, 等. 濒临截肢四肢高压电烧伤患者的保肢策略[J]. 中华烧伤杂志, 2019, 35(11): 776-783. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.003.
[9]	孙鹏, 战杰, 王思夏, 等. 旋股外侧动脉降支穿支皮瓣修复上肢电击伤创面[J]. 中华显微外科杂志, 2019, 42(5): 446-449. DOI: 10.3760/cma.j.issn.1001-2036.2019.05.007.
[10]	Zhu ZX, Wang Y, Liu XY, et al. Repair of experimental high voltage electrical injuries[J]. Acta Chir Plast, 1990, 32(2): 99-106. PMID: 1696056.
[11]	朱志祥, 许晓光, 李伟萍, 等. 急诊综合修复电损伤临床回顾分析[J]. 中华烧伤杂志, 2001, 17(1): 18-21. DOI: 10.3760/cma.j.issn.1009-2587.2001.01.006.
[12]	汪道新, 朱志祥, 许晓光, 等. 激光多普勒血流仪测定兔后肢电损伤局部血流变化[J]. 中国组织工程研究与临床康复, 2007, 11(9): 1701-1703. DOI: 10.3321/j.issn:1673-8225.2007.09.035.
[13]	文一臻, 张丕红, 任利成, 等. 136例上肢电烧伤患者的临床特征及修复效果[J]. 中华烧伤杂志, 2019, 35(11): 784-789. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.004.
[14]	Wong JKF, Deek N, Hsu CC, et al. Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction[J]. J Plast Reconstr Aesthet Surg, 2017, 70(1): 67-77. DOI: 10.1016/j.bjps. 2016. 09.028.
[15]	Soutar DS, Scheker LR, Tanner NS, et al. The radial forearm flap: a versatile method for intra-oral reconstruction[J]. Br J Plast Surg, 1983, 36(1): l-8. DOI: 10.1016/0007-1226(83)90002-4.
[16]	Bullocks J, Naik B, Lee E, et al. Flow-through flaps：a review of current knowledge and a novel classification system[J]. Microsurgery, 2006, 26(6): 439-449. DOI: 10.1002/micr.20268.
[17]	施鸿飞, 熊进. 肢体毁损伤选择保肢还是截肢的争论[J]. 国际骨科学杂志, 2012, 33(4): 261-262. DOI: 10.3969/j.issn.1673-7083. 2012. 04. 015.
[18]	赵刚. 濒临截肢伤保肢治疗学[M]. 北京: 人民军医出版社, 2011: 39-41.
[19]	徐晓峰, 沈铁城. MESI评分法预测四肢损伤性截肢: 回顾性验证93例报告[J]. 中华骨科杂志, 1996, 16(3): 152-155. DOI: 10.1007/BF02951625.
[20]	吴有森, 鲍海华, 孙艳秋, 等. CT血管成像在四肢高压电击伤中的应用[J]. 实用放射学杂志, 2012, 28(10): 1595-1598. DOI: 10.3969/j.issn.1002-1671.2012.10.028.

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

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 20

相关文章 2

Metrics

本文评价

推荐阅读 0

[1]	常树森, 何春念, 陈伟, 周健, 张芳, 聂开瑜, 邓呈亮, 魏在荣. 旋股外侧动脉降支Flow-through皮瓣联合MIPPO于急诊胫腓骨Gustilo IIIC型骨折中的应用研究[J]. 中国临床解剖学杂志, 2022, 40(6): 733-737.
[2]	肖容, 王建华, 吴毓强. 尺动脉腕上穿支下行支flow-through皮瓣在伴有指固有动脉缺损的指创面的应用[J]. 中国临床解剖学杂志, 2019, 37(4): 457-459.