OBJECTIVE: To reduce amputation rate of severe electrical burn of wrist and to promote partial recovery of the injuried hand. METHODS: From 1987 to 1999, 44 cases, with 55 limbs of severe electrical burn were classified into 4 types, according to criteria of Dr Shen Zuyao, and were all treated by primary adequate decompression, timely debridement, reconstruction of blood circulation in cases complicated with blood vessel injury, and skin flap grafting from chest, abdomen or inguinal area, followed by treatment of anti-coaggluation and anti-infection. Once the wound healed, auto- or allo-transplantation or transferring of tendons were performed to repair tendon defect, and auto-nerve or fetal nerve transplantation performed for nerve defect. RESULTS: After the primary treatment of the 55 burned limbs, all limbs of type IV were amputated, and most of other 3 types survived. The function, including sensation and movement, of survived hands partially recovered. CONCLUSION: Primary reconstruction of blood circulation, cover of wound with skin flap, and timely repair of sensation and motor function are very crucial approach to reduce amputation rate and to promote the survived hand function of severe electrical burns of wrists.
High-voltage electric burns is refractory with high rate of amputation (46%) in early stage and unfavorable functional recovery in later stage. Little breakthrough has so far been made in this respect. From Jan. 1985 to Jan. 1996, ninety-six cases with high-voltage burns were treated in our department. Seventy-one cases of various tissue flap grafting were applied to treat early electric burns, among which sixty-four cases were successful. The amputation rate was reduced to 30%. Postoperatively, a long-term rehabilitation training at home was carried out. Most of them achieved a good appearance of the wounded sites and limbs and satisfactory ability to work or self-care. It was suggested that early thorough debridement of necrosis tissue, careful reservation of living tissue, appropriate choice of tissue flap and postoperative rehabilitation training were of great importance to achieve a good prognosis.
Based on the dye injection investigation, the territory of blood supply through the superficial temperal artery system was defined. Vascularized grafts, composed of temperal-parietal fascia, periosteum and outer-table of calvarial bone, can be transferred by microvascular anastomosis or transposed to repair full-thickness defects of skull bone was demonstrated. Six of such cases following electrical burn were successfully treated. The average size of skull bone defects was 50cm2. The largest one among them was 80cm2.