The middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist / 中华整形外科杂志

<p><b>OBJECTIVE</b>To dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.</p><p><b>METHODS</b>From Oct. 2009 to Oct. 2012, 10 cases of electrical burn wounds on the wrist were treated. A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis. At the midpoint of the line, Doppler flow imaging meter was used to detect the emerging point of perforator vessel. The flap was designed and harvested. The flap was transferred reversely, with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases. The wounds in the donor sites were closed directly in 2 cases, and with skin graft in 8 cases.</p><p><b>RESULTS</b>All the 10 flaps survived completely. 7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively, which resovled 1 week later. Sub-flap tissue necrosis and infection happened in 2 cases, which healed after dressing and drainage. Patients were followed up for 3-36 months with satisfactory results.</p><p><b>CONCLUSIONS</b>The middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply. It offers a new choice for the electric burn wound on the wrist, especially at the ulnar side.</p>

Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns.

Sepsis commonly occurs in severe post-burn patients, often resulting in death. We aimed to evaluate the influence of early enteral feeding on outcomes in patients with extensive burns, including infection incidence, healing and mortality. We retrospectively reviewed 60 patients with extensive burns, 35 who had received early enteral nutrition and 25 who had received parenteral nutrition. Average healing time, infection incidence and mortality were clinically observed. Hemoglobin and serum albumin were monitored weekly in both groups during treatment. Causative organisms were identified in patients with sepsis. Infection incidence was significantly less in the enteral nutrition group than the parenteral nutrition group (17.1% vs 44.0%; p = 0.023); and latency duration was longer in the enteral nutrition group than in the parenteral nutrition group (30.5 ± 4.7 days vs 14.5 ± 2.3 days; p<0.001). Duration of antibiotic therapy of the enteral nutrition group was significantly shorter than that of the parenteral nutrition group (12.5 ± 3.0 days vs 19.8 ± 3.6 days; p<0.001). Mean hemoglobin results (10.1 ± 1.3 g/L vs 8.3 ± 1.5 g/L; p<0.001) and serum albumin results (44.7 ± 5.7 g/L vs 36.2 ± 6.9 g/L; p<0.001) of enteral nutrition and parenteral nutrition groups, respectively, provided an overview of systemic nutrition and protein metabolism, suggesting higher systemic nutrition and protein synthesis in enteral nutrition group than in parenteral nutrition group. Risk of post-burn infection is reduced in burn patients who are supported by earliest possible enteral nutrition.

[Repair contracture deformity of perineal scar caused by burn with extra long scapular-lateral thoracic-ilioinguinal Siamese flap].

OBJECTIVE: To assess the efficacy of the extra long scapular-lateral thoracic-ilioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. METHODS: From January 2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were complicated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 +/- 8.8) degrees. And anus could not expose entirely so that squatting and relieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm x 6 cm to 28 cm x 8 cm. The size of extra long scapular-lateral thoracic-ilioinguinal siamese flap ranged from 35 cm x 12 cm to 58 cm x 15 cm. The donor sites were sutured directly. RESULTS: Blister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary healing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 +/- 11.3) degrees, showing significant difference between pre- and post-operation (P < 0.05). The functions of squatting and relieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resection and expanding flaps transposition. CONCLUSION: In view of large donating region, great facility for transposition, stable and sufficient blood supply, reutilization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-ilioinguinal siamese flap for contracture deformity of perineal scar caused by burn.

[Clinical investigation of the correlation between blood concentration of lactic acid and tissue oxygenation in severely burned patients].

OBJECTIVE: To investigate the relationship between blood concentration of lactic acid (LA) and tissue oxygenation in severely burned patients with shock. METHODS: Thirty-four severely burned patients admitted during early postburn stage were included in this study and were randomly divided into A (n = 18) and B (n = 16) groups. The patients in A group were resuscitated with modified anti-shock programme by which the patients' urine output was maintained roughly around 100ml per hour, while the patients in B group were treated by our traditional resuscitation formula by which the patients urine was kept at 40 ml per hour. The blood concentration of LA and usual indices (urine output, blood pressure, heart rate, and mental status) were simultaneously monitored before and 1, 8, 16, 24, 48 and 72 hours after resuscitation in patients of both groups. RESULTS: (1) The average blood LA level in patients of A group was (3.2 +/- 0.4) mmol/L within 24 hours of resuscitation, while the monitored indices remained within normal range. Nevertheless the LA level in B group was (7.4 +/- 1.6) mmol/L (P < 0.01, compared with that of A group), and hyperlactacidemia lasted for more than 72 hours while other indices were normal. (2) The mortality in B group was high (31.2%), whilst that in A-group was only 5.5% (P < 0.01). (3) There was negative correlation between blood LA and urine output and positive correlation between blood LA and heart rate. CONCLUSION: (1) Blood LA concentration might be taken as an immediate, sensitive, simple and useful index of tissue oxygenation of the whole body during burn shock stage. (2) It was suggested by our results that fluid resuscitation should be extended to 72 PBHs (postburn hours) with urine output over 100 ml/h, so as to ensure the quality and effects of the resuscitation of burn shock.

[Repair of murine full skin loss with composite skin of collagen scaffold containing living cells].

OBJECTIVE: To construct composite skin containing living cells and to observe its significance in the repair of full skin loss in mice. METHODS: The dermal substitute was formed by culturing heterogeneous fibroblasts on the acellular chondrocyte collagen scaffold for 3 days, and then cultured on the epithelial membrane for another 10 days, to form the composite skin containing living cells. The composite skin was grafted onto full layer skin defect. The growth condition was observed and biopsies were harvested for histologic examination. RESULTS: Both fibroblasts and stratified epithelium grew well in the collagen scaffold. The composite skin adhered tightly to wounds of the mice, with obvious vascularization one week after grafting. The grafts began to merge with the wound margin at 6 post operation weeks without obvious signs of rejection. CONCLUSION: Full skin loss could be repaired by composite skin formed by acellular chondrocyte collagen scaffold as a skin substitute.