Application of the Flow-through flap of descending branch of lateral circumflex femoral artery in the limb salvage treatment of high-voltage electrical injury of the upper extremity

doi:10.13418/j.issn.1001-165x.2021.06.015

PDF(1478 KB)

Chinese Journal of Clinical Anatomy ›› 2021, Vol. 39 ›› Issue (6) : 707-710. DOI: 10.13418/j.issn.1001-165x.2021.06.015

Application of the Flow-through flap of descending branch of lateral circumflex femoral artery in the limb salvage treatment of high-voltage electrical injury of the upper extremity

Xue Jiajie, Wang Yaojun, Ren Zhongliang, Guo Lei

Author information +

History +

Abstract

Objective　To explore the limb salvage effect of Flow-through flap of descending branch of lateral femoral circumflex artery in the treatment of high-voltage electrical injury of the upper extremity. Methods　From July 2017 to February 2019, five patients with high-voltage electrical injury of upper extremity were analyzed retrospectively. Extensive soft tissue necrosis and blood circulation disorder were found in all of the affected limbs. Emergency treatment including incision and decompression of the affected limb, removal of necrotic tissue, vascular exploration, transplantation of Flow-through flap of descending branch of lateral circumflex femoral artery were implemented to repair the wound and reconstruct the distal blood circulation of the limb. The wound area after thorough debridement ranged from 6.0 cm×4.0 cm to 17.1 cm×10.3 cm, and the flap area ranged from 7.2 cm×5.0 cm to 18.3 cm×11.5 cm. The donor area was closed directly in one stage.　Results　One patient developed subflap infection 7 days after operation and healed successfully after debridement and suturing. The other flaps survived well and healed in stage I. All patients were followed up for 6 to 18 months, with an average of 12 months. All the patients were successful in limb preservation, the skin flap was soft and satisfactory in shape, the ulnar and radial arteries of the affected limb were unobstructed, the blood supply of the hand and wrist was good, and the function was restored to a certain extent. There were lamellar scars in the donor region with only a small area of numbness.　Conclusions　The Flow-through flap of the descending branch of the lateral circumflex femoral artery can effectively reconstruct the blood supply of the limbs and repair the wounds at the same time, which is one of the ideal methods for limb salvage treatment in the high-voltage electrical injury of upper extremity.

Key words

Electric injury;　Flow-through flap;　Emergency operation;　Limb salvage; / Microsurgery technology

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Xue Jiajie, Wang Yaojun, Ren Zhongliang, Guo Lei. Application of the Flow-through flap of descending branch of lateral circumflex femoral artery in the limb salvage treatment of high-voltage electrical injury of the upper extremity[J]. Chinese Journal of Clinical Anatomy. 2021, 39(6): 707-710 https://doi.org/10.13418/j.issn.1001-165x.2021.06.015

References

[1] 蒋梅君, 李泽, 谢卫国, 等. 2133例电烧伤住院患者流行病学调查[J]. 中华烧伤杂志, 2017, 33(12): 732-737. DOI:10.3760/cma.j.issn.1009-2587.2017.12.003.
[2] 孙永华. 我国电烧伤治疗的成就与挑战[J]. 中华烧伤杂志, 2008, 24(5). DOI: 10.3760/cma.j.issn.1009-2587.2008.05.022.
[3] Kasana RA, Baba PUF, Wani AH. Pattern of high voltage electrical injuries in the Kashmir valley: a 10-year single centre experience[J]. Ann Burns Fire Disasters, 2016, 29(4): 259-263.
[4] Fan XM, Ma B, Zeng D, et al. Burns in a major burns center in East China from 2005 to 2014: incidence and outcome[J]. Burns, 2017, 43(7): 1586-1595. DOI: 10.1016/j.burns.2017.01.033.
[5] 唐举玉. 特殊形式穿支皮瓣的临床应用教程[J]. 中华显微外科杂志, 2013, 36(2): 201-205. DOI: 10.3760/cma.j.issn.1001-2036.2013.02.038.
[6] Gencel E, Eser C, Kesiktas E, et al. A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns[J]. Burns, 2016, 42(4): e55-e60. DOI: 10.1016/j.burns.2015.10.014.
[7] Koshima I, Kawada S, Etoh H, et al. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities[J]. Plast Reconstr Surg, 1995, 95(2): 252-260. DOI: 10.1097/00006534-199502000-00004.
[8] 沈余明, 覃凤均, 杜伟力, 等. 濒临截肢四肢高压电烧伤患者的保肢策略[J]. 中华烧伤杂志, 2019, 35(11): 776-783. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.003.
[9] 孙鹏, 战杰, 王思夏, 等. 旋股外侧动脉降支穿支皮瓣修复上肢电击伤创面[J]. 中华显微外科杂志, 2019, 42(5): 446-449. DOI: 10.3760/cma.j.issn.1001-2036.2019.05.007.
[10]Zhu ZX, Wang Y, Liu XY, et al. Repair of experimental high voltage electrical injuries[J]. Acta Chir Plast, 1990, 32(2): 99-106. PMID: 1696056.
[11]朱志祥, 许晓光, 李伟萍, 等. 急诊综合修复电损伤临床回顾分析[J]. 中华烧伤杂志, 2001, 17(1): 18-21. DOI: 10.3760/cma.j.issn.1009-2587.2001.01.006.
[12] 汪道新, 朱志祥, 许晓光, 等. 激光多普勒血流仪测定兔后肢电损伤局部血流变化[J]. 中国组织工程研究与临床康复, 2007, 11(9): 1701-1703. DOI: 10.3321/j.issn:1673-8225.2007.09.035.
[13] 文一臻, 张丕红, 任利成, 等. 136例上肢电烧伤患者的临床特征及修复效果[J]. 中华烧伤杂志, 2019, 35(11): 784-789. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.004.
[14] Wong JKF, Deek N, Hsu CC, et al. Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction[J]. J Plast Reconstr Aesthet Surg, 2017, 70(1): 67-77. DOI: 10.1016/j.bjps. 2016. 09.028.
[15] Soutar DS, Scheker LR, Tanner NS, et al. The radial forearm flap: a versatile method for intra-oral reconstruction[J]. Br J Plast Surg, 1983, 36(1): l-8. DOI: 10.1016/0007-1226(83)90002-4.
[16] Bullocks J, Naik B, Lee E, et al. Flow-through flaps：a review of current knowledge and a novel classification system[J]. Microsurgery, 2006, 26(6): 439-449. DOI: 10.1002/micr.20268.
[17] 施鸿飞, 熊进. 肢体毁损伤选择保肢还是截肢的争论[J]. 国际骨科学杂志, 2012, 33(4): 261-262. DOI: 10.3969/j.issn.1673-7083. 2012. 04. 015.
[18] 赵刚. 濒临截肢伤保肢治疗学[M]. 北京: 人民军医出版社, 2011: 39-41.
[19] 徐晓峰, 沈铁城. MESI评分法预测四肢损伤性截肢: 回顾性验证93例报告[J]. 中华骨科杂志, 1996, 16(3): 152-155. DOI: 10.1007/BF02951625.
[20] 吴有森, 鲍海华, 孙艳秋, 等. CT血管成像在四肢高压电击伤中的应用[J]. 实用放射学杂志, 2012, 28(10): 1595-1598. DOI: 10.3969/j.issn.1002-1671.2012.10.028.