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Objective@#To explore the effect of axial flap of adjacent artery perforator with vascular pedicle in repairing scar deformity of face and neck in patients.@*Methods@#From January 2010 to June 2018, 38 patients with cicatricial deformity of face and neck after deep burn were admitted to author′s unit, including 22 males and 16 females, aged 5-56 years. The time of admission was 7 months to 19 years after burn injury. The size of wounds ranged from 7.0 cm×4.0 cm to 20.0 cm×10.0 cm after scar tissue was released. Nineteen patients were treated by upper thoracic internal artery perforator flap with size ranged from 7.0 cm×5.0 cm to 18.0 cm×8.5 cm. Among them, 16 cases were preexpanded with expanders at thorax whose rated capacity ranged from 300 to 500 mL and times of water injection of 1.8 to 3.1, and 3 cases were directly used. Twelve patients were treated by transverse carotid artery perforator flap with size ranging from 7.0 cm×4.5 cm to 11.0 cm×8.5 cm, of which 8 patients were preexpanded and 4 cases were directly used. The rated capacity of expander placed at the supraclavicular region ranged from 200 to 350 mL with times of water injection from 1.5 to 2.0. Seven patients were treated by preexpanded superficial temporal frontal branch artery perforator flap with size of 5.5 cm×3.8 cm to 8.0 cm×5.0 cm. The rated capacity of expanders placed at forehead was 150 to 300 mL with times of water injection of 1.5 to 2.0. Donor sites were directly sutured or reversely repaired by pedicled skin tube plasty. After operation, operation times and treatment time were recorded. The survival condition and complications of flaps and follow-up were observed.@*Results@#The patients each received 1 to 4 operation (s) with treatment time of 5 to 11 months. All flaps survived after operation. Among them, three flaps with perforating branches of internal thoracic artery had slight blood circulation disturbance at the distal end and were healed after conservative dressing change, etc. Pigment changes were observed at the distal end of thoracic internal artery perforator flaps in two patients in the later stage and was resected and repaired in the second stage. The patients were followed up for 5 to 18 months. The appearance and function of operation area were good with high satisfaction of patient.@*Conclusions@#The axial flap of adjacent artery perforator with vascular pedicle for repairing scar deformity of face and neck used directly or preexpanded can solve the problem of lack of normal skin around scar deformity without vascular anastomosis during the operation and with better appearance and function after operation. The donor site often can be directly sutured, but many operations often need to be completed for finishing whole treatment.
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Objective@#To explore the experience of transportation of mass severe burn patients for long distance by air ambulance with fixed wing.@*Methods@#The organization and implementation process of transportation of 5 patients in the devastating forest fire of Greater Khingan on 2nd, May 2017, for long distance by air ambulance with fixed wing were reviewed and analyzed. All the patients were severely burned and complicated with inhalation injury. Four hours after accident, the relevant authority dispatched national medical team with 2 specialists of burn, 1 specialist of intensive care medicine, 1 head nurse of burn intensive care unit (ICU) to treat and cure the patients before transportation. Three patients had tracheotomy and four patients had escharotomy. Patients and their relatives, expert group of transportation, and aircrew members were arranged according to the scheme before transportation. Patients were monitored and treated with the equipments of air ambulance during the transportation. Patients were transferred to the burn ICU in our hospital from the airport through the green channel.@*Results@#All the five patients were transported to the destination safely for long distance of 1 700 kilometres and air flight 3.5 hours one way by air ambulance with fixed wing in 4 batches at 26 to 44 hours post burn, and transported from tarmac to burn ICU of our hospital. All the patients were in stable condition during the transportation and had successful subsequent rescue. All the patients were discharged in three months.@*Conclusions@#It is feasible to transfer mass severe burn patients for long distance by air ambulance with fixed wing, and it is safer and more effective to transfer according to the standardization process, and the opportunity of transportation of severe burn patients can be moved up to shock stage.
RESUMO
Objective To study the mechanism of glutamine dipeptide on wound healing after operations on bums. Methods Totally, 30 burned patients were randomly divided into study group and control group (15 cases in each group). All patients received parental nutrition support after operation. Study group patients were supplemented with glutamine dipeptide at a dose of 0. 5 g ·kg-1· d-1. The plasma free hydroxyproline level was measured by a standard amino acid analyzer 1 day before operation and 7 days after operation and the wound healing time was recor- ded. Results The plasma free hydroxyproline levels of both groups were higher than the normal values before opera- tion but without significant difference [control group: (2. 24±0. 84) μg/ml, study group: (2. 32±0.92) jig/ml, normal value: (1.27±0.44) μg/ml]. On the post-operative 7 day, the plasma free hydroxyproline level of study group [ (4. 31±1. 05) ng/ml] was significantly higher than that of control group [ (3. 04±1. 01) μg/ml] (P = 0.002). The wound healing time of study group [ (29. 7±5.3) d] was shorter than that of control group but with- out significant difference [ (33. 3±7.5) d, P = 0. 14 ]. Conclusion The intravenous supplementation of glutamine dipeptide may increase the plasma hydroxyproline level after operation and thus promote wound healing.