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Wound repair and functional reconstruction of high-voltage electrical burns in wrists.

Abstract Objective: To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists. Methods: From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type Ⅰ, 69 of type Ⅱ, 9 of type Ⅲ, and 19 of type Ⅳ. According to the wrist injuries, different surgical operations were performed. Forearm amputation was conducted in 20 wrists with necrosis in the distal end. On the basis of fasciotomy for decompression, early debridement was performed on the other 98 wrist wounds. After debridement, wounds with area ranging from 10 cm×7 cm to 30 cm×18 cm were repaired with tissue flaps with abundant blood supply. Thirty-two wounds were repaired with pedicled groin flaps, 11 wounds with pedicled paraumbilical flaps, 3 wounds with pedicled anterolateral thigh island flaps, 9 wounds with combined abdominal axial pattern flaps, 37 wounds with free skin flaps or myocutaneous flaps, and 6 wounds with flow-through descending branch of lateral femoral circumflex artery flaps, with tissue flap area ranging from 12 cm×8 cm to 34 cm×20 cm. Ulnar artery or radial artery vascular reconstruction was performed in 20 wrist wounds. Forty-one donor sites were sutured directly, while 14 were closed by thin split-thickness skin grafts from same-side thighs, and 43 were closed by thin split-thickness skin grafts from opposite-side thighs. Fifty-three wrist wounds were performed with tendon and nerve repair surgery, of which 20 were performed with simple tendon and nerve release surgery. Flexor digitorum profundus tendons and (or) flexor pollicis longus tendons were reconstructed with autologous or allogeneic tendon transplantation in 33 wrist wounds, and the median nerve was repaired with sural nerve graft in 21 wrist wounds. In 6 to 24 months after the last operation, tendon function of 53 wrist wounds which had tendon repair was evaluated with finger total active motion (TAM) method, while median nerve function of 21 wrist wounds which had median nerve repair was evaluated with integrate estimation method. Results: (1) After forearm amputation, the incisions of 20 wrists with necrosis in the distal end were healed. (2) Among the 98 tissue flaps, 90 had good blood flow, while 8 had distal necrosis, of which 6 were healed after necrotic tissue removal and skin grafting, and two were sutured directly after debridement. Infection occurred under 7 flaps, of which 3 were healed by dressing change, and 4 were healed after second debridement. Twenty wrist wounds which had radial artery or ulnar artery repair had good blood supply of hand and amputation was avoided. During follow-up of 1 to 3 years, the incisions and flaps of patients who had tissue flap repair surgery healed well. (3) The excellent and good rate of TAM in each finger of the corresponding affected limbs of 53 wrist wounds which had tendon and nerve repair surgery was 51%. (4) Twenty wrists which had simple tendon and nerve release surgery were followed up for 1 to 2 years. The strength of muscle dominated by the median nerve was restored to grade Ⅴ in 1 wrist, grade Ⅳ in 3 wrists, and grade Ⅲ in 2 wrists. The strength of muscle dominated by the ulnar nerve was restored to grade Ⅳ in 3 wrists, with no recovery in other wrists. Sensory function examination showed grade S0 in 4 wrists, grade S1 in 2 wrists, grade S2 in 3 wrists, grade S3 in 8 wrists, and grade S4 in 3 wrists. Twenty-one wrists which had median nerve repair were followed up for 1 to 2 years. There was no recovery in muscle strength dominated by the median nerve. Sensory function examination showed grade S0 in 3 wrists, grade S1 in 5 wrists, grade S2 in 8 wrists, and grade S3 in 5 wrists. Conclusions: It is a good method to sequentially conduct early fasciotomy for decompression, early debridement, vascular reconstruction, transplant of tissue flap with abundant blood supply, tendon and nerve repair in repairing electrical burn wounds of wrists, avoiding amputation, and reconstructing hand function according to the condition of electrical burns of wrists.
PMID
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Authors

Mayor MeshTerms

Wound Healing

Keywords

Burns, electric

Nerves

Surgical flaps

Tendons

Wrist

Journal Title zhonghua shao shang za zhi = zhonghua shaoshang zazhi = chinese journal of burns
Publication Year Start




PMID- 29275614
OWN - NLM
STAT- MEDLINE
DCOM- 20180105
LR  - 20180105
IS  - 1009-2587 (Print)
IS  - 1009-2587 (Linking)
VI  - 33
IP  - 12
DP  - 2017 Dec 20
TI  - [Wound repair and functional reconstruction of high-voltage electrical burns in
      wrists].
PG  - 738-743
LID - 10.3760/cma.j.issn.1009-2587.2017.12.004 [doi]
AB  - Objective: To explore the methods and effects of wound repair and functional
      reconstruction of high-voltage electrical burns in wrists. Methods: From January 
      2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were 
      hospitalized, with 118 wrist wounds including 21 of type , 69 of type , 9 of type
      , and 19 of type . According to the wrist injuries, different surgical operations
      were performed. Forearm amputation was conducted in 20 wrists with necrosis in
      the distal end. On the basis of fasciotomy for decompression, early debridement
      was performed on the other 98 wrist wounds. After debridement, wounds with area
      ranging from 10 cmx7 cm to 30 cmx18 cm were repaired with tissue flaps with
      abundant blood supply. Thirty-two wounds were repaired with pedicled groin flaps,
      11 wounds with pedicled paraumbilical flaps, 3 wounds with pedicled anterolateral
      thigh island flaps, 9 wounds with combined abdominal axial pattern flaps, 37
      wounds with free skin flaps or myocutaneous flaps, and 6 wounds with flow-through
      descending branch of lateral femoral circumflex artery flaps, with tissue flap
      area ranging from 12 cmx8 cm to 34 cmx20 cm. Ulnar artery or radial artery
      vascular reconstruction was performed in 20 wrist wounds. Forty-one donor sites
      were sutured directly, while 14 were closed by thin split-thickness skin grafts
      from same-side thighs, and 43 were closed by thin split-thickness skin grafts
      from opposite-side thighs. Fifty-three wrist wounds were performed with tendon
      and nerve repair surgery, of which 20 were performed with simple tendon and nerve
      release surgery. Flexor digitorum profundus tendons and (or) flexor pollicis
      longus tendons were reconstructed with autologous or allogeneic tendon
      transplantation in 33 wrist wounds, and the median nerve was repaired with sural 
      nerve graft in 21 wrist wounds. In 6 to 24 months after the last operation,
      tendon function of 53 wrist wounds which had tendon repair was evaluated with
      finger total active motion (TAM) method, while median nerve function of 21 wrist 
      wounds which had median nerve repair was evaluated with integrate estimation
      method. Results: (1) After forearm amputation, the incisions of 20 wrists with
      necrosis in the distal end were healed. (2) Among the 98 tissue flaps, 90 had
      good blood flow, while 8 had distal necrosis, of which 6 were healed after
      necrotic tissue removal and skin grafting, and two were sutured directly after
      debridement. Infection occurred under 7 flaps, of which 3 were healed by dressing
      change, and 4 were healed after second debridement. Twenty wrist wounds which had
      radial artery or ulnar artery repair had good blood supply of hand and amputation
      was avoided. During follow-up of 1 to 3 years, the incisions and flaps of
      patients who had tissue flap repair surgery healed well. (3) The excellent and
      good rate of TAM in each finger of the corresponding affected limbs of 53 wrist
      wounds which had tendon and nerve repair surgery was 51%. (4) Twenty wrists which
      had simple tendon and nerve release surgery were followed up for 1 to 2 years.
      The strength of muscle dominated by the median nerve was restored to grade in 1
      wrist, grade in 3 wrists, and grade in 2 wrists. The strength of muscle dominated
      by the ulnar nerve was restored to grade in 3 wrists, with no recovery in other
      wrists. Sensory function examination showed grade S0 in 4 wrists, grade S1 in 2
      wrists, grade S2 in 3 wrists, grade S3 in 8 wrists, and grade S4 in 3 wrists.
      Twenty-one wrists which had median nerve repair were followed up for 1 to 2
      years. There was no recovery in muscle strength dominated by the median nerve.
      Sensory function examination showed grade S0 in 3 wrists, grade S1 in 5 wrists,
      grade S2 in 8 wrists, and grade S3 in 5 wrists. Conclusions: It is a good method 
      to sequentially conduct early fasciotomy for decompression, early debridement,
      vascular reconstruction, transplant of tissue flap with abundant blood supply,
      tendon and nerve repair in repairing electrical burn wounds of wrists, avoiding
      amputation, and reconstructing hand function according to the condition of
      electrical burns of wrists.
FAU - Shen, Y M
AU  - Shen YM
AD  - Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
FAU - Ma, C X
AU  - Ma CX
FAU - Qin, F J
AU  - Qin FJ
FAU - Zhang, C
AU  - Zhang C
FAU - Wang, C
AU  - Wang C
FAU - Hu, X H
AU  - Hu XH
LA  - chi
PT  - Journal Article
PL  - China
TA  - Zhonghua Shao Shang Za Zhi
JT  - Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns
JID - 100959418
SB  - IM
MH  - Adult
MH  - Burns, Electric/*surgery
MH  - Debridement
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocutaneous Flap
MH  - Reconstructive Surgical Procedures/*methods
MH  - Skin Care
MH  - Skin Transplantation
MH  - Soft Tissue Injuries/therapy
MH  - Surgical Flaps
MH  - *Wound Healing
MH  - Wrist Injuries/etiology/*surgery
OTO - NOTNLM
OT  - Burns, electric
OT  - Nerves
OT  - Surgical flaps
OT  - Tendons
OT  - Wrist
EDAT- 2017/12/26 06:00
MHDA- 2018/01/06 06:00
CRDT- 2017/12/26 06:00
PHST- 2017/12/26 06:00 [entrez]
PHST- 2017/12/26 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
PST - ppublish
SO  - Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):738-743.