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目的 :探讨严重电击伤的手术时机 ,术前创面处理和皮瓣的选择。方法 :对 5 1例严重电击伤的临床资料进行分析。结果 :5 1例均行手术治疗 ,其中截肢 32例 ,植皮修复 34例 ,皮瓣移植修复 31例。头面部手术均在受伤 7天后进行。受伤 7天内四肢植皮 8例 ;7天后经创面处理再植皮 2 6例 ,其中头面部 18例 ,四肢 8例 ,34例植皮均成活。受伤 7天内四肢皮瓣移植成活率 67% (12 /18) ,7天后的皮瓣移植经术前创面处理成活率 77% (10 /13) ,P>0 .0 5 ,其中头面部 6例成活 5例 ,四肢 7例成活 5例。用远位带蒂皮瓣修复的 6例均成活 ,而用邻近随意皮瓣修复的成活率仅 61% (14/2 3)。头面部伤在伤后 10～ 14天手术 ;四肢伤创面无感染者在伤后 3～ 7天手术 ;受伤 7天以后的创面有感染者经过适当术前创面处理后再手术 ;腹部伤有急腹症早期表现时立即剖腹探查均取得较好的临床疗效。结论 :掌握不同部位的手术时机、采用适当的术前创面处理和选用合适的皮瓣修复创面是治疗严重电击伤成功的关键。
Objective: To investigate the timing of surgery for severe electrical injury, preoperative wound management and flap selection. Methods: Clinical data of 51 severe electric shocks were analyzed. Results: All the 51 patients underwent surgical treatment, including 32 cases of amputation, 34 cases of skin grafting and 31 cases of flap grafting. Head and face surgery were carried out after 7 days of injury. There were 8 cases of limbs skin graft in 7 days and 26 cases of skin graft after 7 days. Among them, 18 cases of head and face, 8 cases of limbs and 34 cases of skin grafts survived. Survival rate of limb flap transplantation was 67% (12/18) within 7 days after injury, and 7 days after skin flap surgeries survival rate was 77% (10/13), P> 0.05, including 6 cases of head and face Survival in 5 cases, limbs in 7 cases survived in 5 cases. Six cases with distal pedicle flap survived, while the survival rate with adjacent random flap repair was only 61% (14/2). Head and facial injuries in 10 to 14 days after surgery surgery; limb wounds without infection in patients with wound surgery 3 to 7 days after injury; 7 days after the wound infection in patients with appropriate preoperative wound treatment before surgery; abdominal injury Early performance of abdominal disease immediately laparotomy exploration have achieved better clinical efficacy. Conclusion: To grasp the timing of operation in different parts, the appropriate preoperative wound treatment and selection of suitable skin flap repair wounds is the key to the successful treatment of severe electric shock injury.