中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2012年
6期
415-418
,共4页
许喜生%陈凯%李柏同%周海洋%马铮铮%周永生%欧才生%程勇%黄云%胡永才%张义%王永飞
許喜生%陳凱%李柏同%週海洋%馬錚錚%週永生%歐纔生%程勇%黃雲%鬍永纔%張義%王永飛
허희생%진개%리백동%주해양%마쟁쟁%주영생%구재생%정용%황운%호영재%장의%왕영비
烧伤,电%头部%外科皮瓣
燒傷,電%頭部%外科皮瓣
소상,전%두부%외과피판
Burns,electric%Head%Surgical flaps
目的 探讨头部深度高压电烧伤创面的修复方法. 方法 2002年6月-2012年5月,笔者单位共收治头部深度高压电烧伤患者26例,均为高压电(电压380 V～300 kV)接触导致头部及全身多处深度电烧伤,烧伤总面积为1％～75％ TBSA,深度为深Ⅱ～Ⅳ度.头皮缺损面积为3 cm×2 cm～20 cm×18 cm,颅骨外露最大面积为12 cm×9 cm,颅骨缺损最大面积为7 cm×6 cm.应用局部推进皮瓣、双侧旋转皮瓣、局部旋转皮瓣结合供瓣区薄中厚皮片移植、吻合血管的游离股前外侧皮瓣、创面愈合前早期扩张器治疗、创面愈合后期扩张器治疗以及薄中厚皮片移植修复创面.结果 术后各种皮瓣及薄中厚皮片均成活良好,其中1例有深Ⅱ度创面存在的局部旋转皮瓣并发伤口感染,予以换药缝合后愈合.置入的扩张器扩张顺利.术后随访15 d～3年,15例患者完整修复,预后效果良好. 结论 头部深度高压电烧伤的修复,应根据损伤面积及病情,选用合适的皮瓣结合供瓣区植皮、扩张器置入等方式治疗.
目的 探討頭部深度高壓電燒傷創麵的脩複方法. 方法 2002年6月-2012年5月,筆者單位共收治頭部深度高壓電燒傷患者26例,均為高壓電(電壓380 V～300 kV)接觸導緻頭部及全身多處深度電燒傷,燒傷總麵積為1％～75％ TBSA,深度為深Ⅱ～Ⅳ度.頭皮缺損麵積為3 cm×2 cm～20 cm×18 cm,顱骨外露最大麵積為12 cm×9 cm,顱骨缺損最大麵積為7 cm×6 cm.應用跼部推進皮瓣、雙側鏇轉皮瓣、跼部鏇轉皮瓣結閤供瓣區薄中厚皮片移植、吻閤血管的遊離股前外側皮瓣、創麵愈閤前早期擴張器治療、創麵愈閤後期擴張器治療以及薄中厚皮片移植脩複創麵.結果 術後各種皮瓣及薄中厚皮片均成活良好,其中1例有深Ⅱ度創麵存在的跼部鏇轉皮瓣併髮傷口感染,予以換藥縫閤後愈閤.置入的擴張器擴張順利.術後隨訪15 d～3年,15例患者完整脩複,預後效果良好. 結論 頭部深度高壓電燒傷的脩複,應根據損傷麵積及病情,選用閤適的皮瓣結閤供瓣區植皮、擴張器置入等方式治療.
목적 탐토두부심도고압전소상창면적수복방법. 방법 2002년6월-2012년5월,필자단위공수치두부심도고압전소상환자26례,균위고압전(전압380 V～300 kV)접촉도치두부급전신다처심도전소상,소상총면적위1％～75％ TBSA,심도위심Ⅱ～Ⅳ도.두피결손면적위3 cm×2 cm～20 cm×18 cm,로골외로최대면적위12 cm×9 cm,로골결손최대면적위7 cm×6 cm.응용국부추진피판、쌍측선전피판、국부선전피판결합공판구박중후피편이식、문합혈관적유리고전외측피판、창면유합전조기확장기치료、창면유합후기확장기치료이급박중후피편이식수복창면.결과 술후각충피판급박중후피편균성활량호,기중1례유심Ⅱ도창면존재적국부선전피판병발상구감염,여이환약봉합후유합.치입적확장기확장순리.술후수방15 d～3년,15례환자완정수복,예후효과량호. 결론 두부심도고압전소상적수복,응근거손상면적급병정,선용합괄적피판결합공판구식피、확장기치입등방식치료.
Objective To explore the methods for repairing deep wound on the head due to highvoltage electrical burn (HEB).Methods Twenty-six patients with deep wounds on the head due to HEB were hospitalized from June 2002 to May 2012.They were all injured by high-voltage (voltage ranged from 380 V to 300 kV) electric current,involving head and several other parts over the body.The total burn area ranged from 1％ to 75％ TBSA,and the depth ranged from deep partial-thickness to full-thickness (including muscle or even bone).Scalp defect area ranged from 3 cm× 2 cm to 20 cm × 18 cm,and the maximum size of skull exposure was 12 cm× 9 cm and the maximum size of skull defect was 7 cm × 6 cm.The wounds of 26 patients were repaired with 7 local advance flaps,4 bilateral rotation flaps,18 local rotation flaps combined with thin split-thickness skin grafts in donor site,and 3 free anterolateral thigh flaps with vascular anastomosis.In four of the 26 patients,expander was used in the early stage after burn and 5 after wound healing (with thin split-thickness grafts).Results All flaps and skin grafts survived,except for one flap which was complicated by wound infection,and it was healed after dressing and secondary suturing.The implanted expander expanded smoothly.Patients were followed up for 15 days to three years after surgery.Satisfactory results were obtained,and wounds of 15 patients were repaired completely.Conclusions Deep wound on the head due to HEB should be repaired with suitable flap combined with skin graft in donor site,and implantation of expander according to the injury area and condition of patient.
