ABSTRACT
Objective To investigate the surgical indications and repair methods for the treatment of electrical bums in the limbs.Methods Thirty-eight cases since May,1997 to June,2014 who underwent flap treatment in 7-14 days after electrical bums was summarized.Among these patients,4 cases were treated by local flaps,1 case was treated by thenar flap,2 cases were treated by dorsal island skin flap of the index finger,1 case was treated by cross-leg flap,1 case was treated by medial plantar skin flap;2 cases were treated by pedicle latissimus dorsi flaps,4 cases were treated by antebrachial flap with a pedicle of the posterior interosseous artery,4 cases were treated by metacarpal artery reversed island flaps,10 cases were treated by groin flaps;1 case was treated by free radial artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1％,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9％.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1％.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.
ABSTRACT
Objective To analysis the clinical diagnosis and treatment of the scaphoid and lunate bone fracture with (or) wrist dislocation.Methods A retrospective analysis of the clinical data included 77 cases,which got admitted according to the inclusion and exclusion criteria and followed up completely from 2005 to 2013.In this group,there were 64 males and 13 females whose age arranged from 15 to 73 with a mean age of 31.9.There were 41 cases of simple fracture,32 cases of bone fracture with dislocation and 4 cases of simple dislocation.Treatment of cases was divided into the conservative treatment group (9 cases) and the surgery group (68 cases).The surgery group was further divided into four subgroups according to surgical method (i.e.compression screw fixation,Kirschner wire fixation,proximal row of carpal resection,and lunate excision head shaped bone transposition).Clinical outcome was evaluated based on modified Mayo wrist score and X-ray.Results All of 77 patients were followed up completely.Follow-up time arranged from 6 months to 8 years,with an average follow-up time of 3 years and 5 months.9 cases were treated conservatively.In the surgical treatment group,there were 36 cases of compression screw fixation,34 cases of Kirschner wire fixation,1 case of proximal row of carpal resection and 1 case of the lunate bone resection heads transposition.The average healing time of compression screw group was 6.1 weeks and the Kirschner group was 7 weeks.According to the modified Mayo wrist score,excellent:51 cases (66.2％),good:11 cases (14.3％),fair:9 cases,and poor:6 cases.The rate of excellent and good was 80.5％.The cure rate of compression screw treatment was 97％,and 85％ of Kirschner.The difference of cure rate was statistically significant.After surgery,there were four cases that got scaphoid malunion.The degree of deformity was not serious with only one case happened in the dominant hand,and the wrist pain got better after symptomatic treatment.1 case of scaphoid fracture with dislocation had the problem of wrist instability.18 weeks later,with ligament tightening surgery,postoperative Mayo score went back to excellent.Conclusion Lateral X-ray film of wrist is a preferred method for the examination of scaphoid and lunate fractures with (or) dislocation.Since it's easy to misdiagnose,films of special position are needed to be added.Surgery is preferred for treatment,and the selecting of surgical methods are based on the situation of fracture and dislocation.The advantages of screw fixation are obvious.