Repair of deep wound on the head due to high-voltage electrical burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods for repairing deep wound on the head due to high-voltage electrical burn (HEB).</p><p><b>METHODS</b>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).</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSIONS</b>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.</p>

Experience in the treatment of severe pressure sore / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in the treatment of severe pressure sore.</p><p><b>METHODS</b>From Aug. 2007 to Jun. 2011, 21 cases of severe pressure sore with 43 III-IV degree lesions were treated with combination treatment, including vacuum sealing drainage technique, local fascia flaps, upper or lower gluteus maximus island myocutaneous flaps, lower gluteus maximus myocutaneous flap, neurocutaneous femoris posterior flaps, tensor fascia lata island myocutaneous flaps, free latissimus dorsi myocutaneous flaps, and skin graft, combined with stryker frame and nursing tracking guidance. 13 of 21 cases had multiple pressure sore. Among them, 5 III degree pressure sores were covered by skin grafting and 3 non-caudal III degree pressure sores (< 2 cm in width) were directly closed after debridement. 8 of 21 cases had single IV degree pressure sore.</p><p><b>RESULTS</b>All the 43 wounds healed completely. 5 wounds in 3 cases had effusion under flap which healed after re-drainage. The wounds were not healed in 3 cases with flap transposition which were also healed after re-debridement. All the flaps survived completely. 16 cases were followed up for 2-26 months. Recurrence happened in 4 cases after discharge because of not following the required nursing care.</p><p><b>CONCLUSIONS</b>Comprehensive application of vacuum sealing drainage technique, multiple myocutaneous flaps and skin grafting, combined with stryker frame and nursing tracking guidance after discharge can be used for the treatment of severe pressure sore with satisfactory results.</p>

Reverse small saphenous vein-sural neurovascular island flap for t he reconstruction ofsoft tissue defect on foot and ankle in children / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of reversed small saphenous vein-sural neurovascular island flap for reconstruction of soft tissue defect on foot and ankle in children.</p><p><b>METHODS</b>From July 2006 to June 2008, 8 children with soft tissue defects on foot, heel or ankle were treated with reversed small saphenous vein-sural neurovascular island flaps. The size of flaps ranged from 6 cm x 5 cm to 9 cm x 7 cm. The upper margin of the flaps reached the upper third of cruris, with 1 case reaching the transverse line of popliteal fossa.</p><p><b>RESULTS</b>All the flaps survived. The patients were followed up for 1 - 17 months with good aesthetic and functional results. The growth of the two legs had no difference. The sensation of the flaps improved with no heel ulcer and no dysfunction at the donor site. The upper boundary of flaps can reach the upper third of the cruris even the reansverse line of popliteal fossa. The rotation point of the flaps located at 4 - 6 cm above the lateral ankle in children.</p><p><b>CONCLUSIONS</b>The reversed small saphenous vein-sural neurovascular island flap in children has a reliable survival area. The operation is easily performed without any obvious influence on the growth of the operated cruris. It is a good reconstructive method for soft tissue defect in foot and ankle.</p>

Repair of high-voltage electric burn in jaw and neck region with insular pectoralis major myocutaneous flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of insular pectoralis major myocutaneous flap on repair of jaw and neck tissue defect as a result of high-voltage electric burn.</p><p><b>METHODS</b>Eighteen patients with large area tissue defect in jaw and neck caused by high-voltage electric burn hospitalized from August 2001 to December 2007 were repaired with insular pectoralis major myocutaneous flap. The flaps (from 12 cm x 10 cm to 16 cm x 13 cm) was transplanted in 8 patients after early wound debridement, and in 10 patients on infected wounds.</p><p><b>RESULTS</b>All flaps survived wells except in 4 patients necrotic area (length 2-5 cm, width 1-2 cm) appeared in the distal wound edge, localized dehiscence of wound edge in 2 cases, which were healed after dressing change or secondary suturing. Patients were followed up from 6 months to 3 years, and the appearance and function were satisfactory.</p><p><b>CONCLUSIONS</b>Pectoralis major muscle island myocutaneous flap has the advantage of large tissue mass, with thin and flat muscle belly, and rich blood supply, which is suitable for repair of large deep tissue defect in jaw and neck.</p>

Repair of high-voltage electrical burn in the neck / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore methods of repair of high-voltage electrical burn in the neck.</p><p><b>METHODS</b>Thirty-seven patients with high-voltage electrical burn in neck hospitalized since 1985 were enrolled in this study. After debridement, the wounds were repaired with latissimus dorsi myocutaneous flap, trapezius myocutaneous flap, platysma myocutaneous flaps, pectoralis major myocutaneous flap, or latissimus dorsi myocutaneous flap combined with pectoralis major myocutaneous flap.</p><p><b>RESULTS</b>Necrosis occurred at edge of flap (about 1 - 2 cm in breadth) in 3 patients, and the other flaps survived well with perfect appearance and local function.</p><p><b>CONCLUSION</b>To repair with pedicled myocutaneous flaps and combined flaps after early debridement can be safe, effective and reliable in the management of patients with high-voltage electrical burn in the neck.</p>

Clinical observation of the efficacy of MEBO in the treatment of burn patients with burn area over 50% TBSA / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effectiveness of MEBO in the treatment of burn patients with burn area over 50% TBSA.</p><p><b>METHODS</b>Two hundred and ninety-eight patients hospitalized in our hospital from May of 1991 to December of 2003 with burn area over 50% TBSA, who had MEBO treatment before hospitalization, were enrolled in the study as the experiment (E) group. Another group of 300 burn patients with burn area over 50% TBSA that treated with SD-Ag cream were enrolled in the study as the control (C) group. Bacterial culture results, major changes in injury and mortality were compared between the two groups.</p><p><b>RESULTS</b>There were 1 506 bacteria strains isolated from wounds in E group, and 9 main changes in injury (1679 cases) occurred with 20.8% mortality in this group. There were 353 bacteria strains isolated, with occurrence of 9 changes in injury (518 cases) and 4.7% mortality in the SD-Ag group.</p><p><b>CONCLUSION</b>MEBO is much less effective for the treatment of the burn patients with large burn area compared with SD-Ag cream treatment.</p>