探讨多部位电烧伤毁损性创面的修复方法。

回顾性分析2016年9月至2022年10月首都医科大学附属北京积水潭医院烧伤科收治的38例多部位毁损性电烧伤患者临床资料。其中男37例，女1例，年龄9～61岁，平均37岁。37例致伤电压为6～35 kV，1例为380 V。电烧伤涉及2个部位5例，3个及以上部位33例。早期全面评估患者情况，全身支持治疗。涉及重要脏器损伤患者，给予胸腔闭式引流及坏死肺组织、坏死穿孔肠管切除。涉及肢体尤其腕部电烧伤患者，急诊腕部切开减张，血运未改善者需行静脉桥接尺桡动脉挽救肢体。再根据毁损性创面的部位及损伤程度，合理安排手术时机，采用适合皮瓣修复创面。

本组38例患者，其中37例患者修复效果良好，1例患者死亡。烧伤部位涉及肢体及躯干(胸部、腹部、背部、头部)17例，只涉及四肢21例。采用游离腹壁下动脉为蒂的脐旁穿支皮瓣13个，游离股前外侧皮瓣23个，岛状下斜方肌肌皮瓣4个，游离背阔肌肌皮瓣2个，带蒂背阔肌肌皮瓣7个，带蒂腹直肌肌皮瓣3个，带蒂阔筋膜张肌肌皮瓣1个，带蒂股前外侧皮瓣4个，游离腓肠内侧皮瓣3个，肋间动脉穿支皮瓣1个，游离上臂内侧皮瓣1个，游离跖外侧皮瓣1个，游离腓浅动脉穿支皮瓣1个，局部皮瓣3个，皮瓣全部成活。随访3～18个月，毁损性创面修复效果良好，腹壁创面患者无腹壁疝发生。15例患者再次入院行肌腱重建及皮瓣修整术，4例头部皮瓣移植患者放置头皮扩张器，修复秃发畸形。

对于多部位毁损性电烧伤患者，各部位、各组织、各脏器应区别对待，先保证生命，再保留肢体，根据患者毁损性创面的部位及损伤程度，合理安排手术时机及手术方案，与相关科室医师通力合作，才能更好地进行创面修复和功能重建，降低致残率。

To explore the repair method of multi-site destructive electrical burn wounds.

The clinical data of 38 patients with multiple-site destructive electrical burns admitted to the Burns Department of Beijing Jishuitan Hospital, Capital Medical University from September 2016 to October 2022 were retrospectively analysed, including 37 males and 1 female, aged 9-61 years, with an average age of 37 years. The injury voltage was 6-35 kV in 37 cases and 380 V in 1 case. There were 5 cases involving two parts, and 33 cases involving three or more parts. Early comprehensive evaluation of the patient′s condition and systemic support treatment were carried out. If vital organ injuries were involved, closed thoracic drainage, and necrotic lung tissue, necrotic perforated intestinal resection be performed. When electrical burns of limbs, especially wrists were involved, emergency wrist incision was performed to reduce tension, and venous bridging of the ulnar radial artery was needed to save limbs if blood supply was not improved. According to the location and injury degree of the destructive wounds, reasonable operation timing was arranged, and suitable flaps were used to repair the wounds.

Among the 38 patients, 37 patients had good results and 1 patient died. There were 17 cases of burns involving limbs and trunk (chest, abdomen, back, head), and 21 cases only involving limbs. There were 13 free paraumbilical perforator flaps pedicled with the inferior epigastric artery, 23 free anterolateral thigh flaps, 4 island inferior trapezius myocutaneous flaps, 2 free latissimus dorsi myocutaneous flaps, 7 pedicled latissimus dorsi myocutaneous flaps, 3 pedicled rectus abdominis myocutaneous flaps, 1 pedicled tensor fasciae latae myocutaneous flap, 4 pedicled anterolateral thigh flaps, 3 free medial sural flaps, 1 intercostal artery perforator flap, 1 free medial upper arm flap, 1 free lateral metatarsal flap, 1 free superficial peroneal artery perforator flap and 3 local flaps. All flaps survived. During the follow-up of 3-18 months, the repair effect of destructive wounds were good. There was no abdominal wall hernia in patients with abdominal wall wounds. Fifteen patients were re-admitted for tendon reconstruction and flap repair. Four patients with scalp flaps were placed with scalp expanders to repair alopecia.

For patients with multi-site destructive electrical burns, different parts, tissues and organs should be treated differently. Save lives first, then preserve limbs, according to the location and injury degree of the destructive wounds, arrange reasonable surgical timing and surgical plan. Cooperate with doctors in relevant departments to better carry out wound repair and functional reconstruction, and reduce disability rate.