Repair of electrical burns on hands with flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the experiences and shortcomings of repair of wounds on hands due to electrical burns with flaps, aiming at further improvement.</p><p><b>METHODS</b>Clinical data of 425 patients with electrical burn of hands admitted to Burn Institute of Wuhan, City Hospital NO. 3 & Tongren Hospital of Wuhan University from January 2000 to December 2006 were collected and summarized. Therapeutic methods and outcomes of all patients were statistically analyzed. Flap types, complications after surgery and problems existed in patients having undergone flap transplantation were summarized. Patients were divided into surgery within 7days post burn (PBD) group (SW) and surgery after PBD 7 group (SA) according to the timing of surgery. Survival rate of flaps and incidence of complications in patients of two groups were compared.</p><p><b>RESULTS</b>Out of the 425 patients, 348 (90.2%) patients underwent surgery, among which 248 flaps of different types were transplanted in 209 patients, including 202 (81.5%) distant pedicle flaps, 19 (7.7%) local flaps, 12 (4.8%) free flaps, and 15 (6.0%) other kinds of tissue flaps. Five flaps failed because of necrosis of torn off, and the resulting wounds were treated with other methods. Eight flaps showed necrosis of distal margin, and the wound healed with dressing changing or skin grafting. All the remaining flaps survived with satisfactory cosmetic and functional results. In SW group (n = 170) and SA group (n = 78), survival rate of flaps was respectively 98.8% (168/170) and 96.2% (75/78), incidence of complications was respectively 10.6% (18/170) and 12.8% (10/78). There was no statistical difference between above two sets of data (with chi(2) value respectively 0.81 and 0.27, and P values both above 0.05).</p><p><b>CONCLUSIONS</b>There are many types of flaps that can be used to repair electric burn wounds on hands. Appropriate choice and design of flaps, skillful operation, and careful post-operation observation and treatment are key points for good therapeutic effect.</p>

Rescue and treatment for the mass burn casualties of yellow phosphorus explosion / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the characteristics and treatment of burn casualties of yellow phosphorus explosion, so as to share the experiences in emergency treatment.</p><p><b>METHODS</b>By analyzing the data related to this accident, the characteristics of the injury and experiences of treatment for mass burn casualties from yellow phosphorous explosion were summarized.</p><p><b>RESULTS</b>Eighty-one patients, 72 males and 9 females, were injured in a yellow phosphorus explosion. The mean age of the patients was 24 +/- 13 years old (5-42 y). The mean total burn surface area was (9 +/- 11)% [(0.4% - 70.0%))] TBSA, and the mean burn surface area of III degrees/IV degrees was (7 +/- 10)% [(0.4% - 60.0%)] TBSA. Most of the patients showed the symptoms and signs of phosphorus poisoning. Among all the patients, 27 cases (33.3%) showed hepatic dysfunction, 15 cases (18.5%) had renal dysfunction, 42cases (51.9%) showed electrolytes disorders. Among the 8 patients with burn surface area over 10% TBSA and less than 20% TBSA, high levels of cardiac enzymes were found in 6 cases, anaemia in 7 cases (3 with progressive anaemia), asphyxia occurred in 1 case 48 hours after burn, and in 1 case complicated with stress ulcer. Escharectomy and skin grafting were performed within four days after burn in 72 patients. All the patients survived, some of them showed impaired hand function and hypertrophic scar, and partial finger amputation was done in 3 patients.</p><p><b>CONCLUSION</b>Yellow phosphorus explosion produces deep burn injuries in surrounding people especially in exposed parts such as head, hand and so on. Adequate organization of medical resources for emergency treatment, early debridement, and accelerating excretion of phosphorus are the key points for the successful rescue of mass casualties.</p>

Application of reverse island flaps pedicled with cutaneous nerve nutrient vessels to repair defect on distal parts of extremities / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the feasibility of reverse island flaps pedicled with cutaneous nerve nutrient vessels in repairing the defect on distal parts of extremities.</p><p><b>METHODS</b>Thirty patients with tissue defect in distal extremities, complicated by exposed vessels, nerve, tendons, and/or bones ,were repaired with island flaps pedicled with neurocutaneous nutrient vessel. Among them, five cases were grafted with flaps with external forearm cutaneous nerve vessels, eleven cases were grafted with flap containing sural neural nutrient vessels in its pedicle,and 14 cases with saphenous nerve nutrient vessels in the pedicles.</p><p><b>RESULTS</b>The flaps of 28 cases survived with perfect appearance and function. In one case partial necrosis occurred because of compression on the pedicle, but the patient healed after dressing, and another case with necrosis of the edge of the flap due to infection, but also healed after skin grafting.</p><p><b>CONCLUSION</b>The reverse island flaps pedicled with cutaneous nerve nutrient vessels which are constant in anatomy, with reliable blood supply, can be recommended because its simple operative technique, non-injurious to main blood vessels and muscles, the repair of distal defects of the extremities.</p>