Application Of Free Anterolateral Thigh Perforator Flap Based On The Concept Of Donor Site Protection In Electric Burn Wounds

BackgroundWith the application of electric power in people’s life becomes more and more common and has an indispensable position,electric power has gradually become one of the main injury factors of burn patients,and the number of patients with electric burn,especially high-voltage electric burn,is increasing year by year.Compared with ordinary thermal burn,the injury mechanism of electrical burn is more complex.It is the result of a combination of various thermal and non-thermal processes.It is easy to cause three-dimensional damage to deep tissues and surface skin.The damage range is deep and wide,and may be accompanied by brain complications and injury to the organs of the chest and abdomen,shock,etc.and it has a high disability and fatality rate,which causes a heavy burden on society and patients’ families.This kind of special burn is tricky in clinical treatment,and because a large part of the electric burn wound is accompanied by bone and tendon exposure,sometimes it can not be completely repaired by traditional skin grafting,and the treatment cycle is long.In recent years,with the development of microsurgery,the free anterolateral thigh perforator flap has achieved good clinical results in repairing electrical burn wounds.However,it is difficult to close the donor site of the larger area flap directly.It is often necessary to close the donor site wound by skin grafting.This will not only cause the skin graft survival failure,local discomfort,severe scar hyperplasia and other complications,but also cause the second donor site.At present,most of the skin flaps are used to cover the wound and protect the function of the recipient area,but the protection of the donor area is ignored.In this study,the anterolateral thigh perforator flap was cut to repair the electric burn wound by using the concept of donor site protection,so that the donor site can be closed directly while repairing the wound,avoiding the formation of skin graft and the second donor site,so as to achieve the protection of the donor site.ObjectiveTo explore the clinical application effect of free anterolateral thigh perforator flap based on the concept of donor site protection in repairing electric burn wounds.Methods34 patients with electrical burns who were admitted to the First Affiliated Hospital of Zhengzhou University from May 2015 to September 2020 were selected.Free anterolateral thigh perforator flaps were used to repair the wounds.Conventional flaps were mainly used to take into account the function of the receiving area,ignoring the protection of the donor site.In this study,the anterolateral thigh perforator flap was cut with the concept of donor site protection,so that the donor site could be closed directly,avoiding the formation of skin graft and second donor site.The specific implementation method is as follows:1.For the smaller area of the anterolateral thigh flap,it can be directly sutured after resection.Deep fascia was preserved during the operation to prevent postoperative complications such as muscle hernia.The suture technique adopts the concept of cosmetic surgery to suture,and the donor area is fully layered to reduce the tension,etc.reducing the use of electrosurgical surgery during the operation can reduce postoperative fat liquefaction;2.The large area of the anterolateral thigh flap is cut in the form of lobulated flap.On the one hand,it can avoid the donor site skin grafting,and on the other hand,it can reduce the tension of the donor site and avoid the growth of scars to reach the donor site of the flap maximum protection of appearance and function;3.For skin flaps with poor perforator vessel conditions,the form of lobulated flap cannot be used.Intraoperative or postoperative skin expansion can be used to seal the donor site to reduce the chance of skin grafting.Regular follow-up of the effect of wound repair and the appearance and function of the donor site in patients with electrical burns after the operation.ResultsAmong the 34 patients,31 flaps survived well without vascular crisis;2 flaps had blood flow disorder at the distal edge and the wound healed completely after dressing change;1 flap had necrosis and was repaired with free latissimus dorsi flap.The survival rate of flap was 97.05%.The donor sites were closed directly in 16 cases,lobulated in 11 cases and skin distractor in 7 cases.All the 33 patients in donor site healed well in the first stage,and 1 patient with local incision dehiscence was completely healed after dressing change and skin suture device closure.34 patients were followed up for 2～9 months.In the follow-up of 34 patients,the wound healed well,the appearance was slightly bloated,the texture was soft,the skin color was similar to normal skin,and there was no ulceration,itching and pain.Among the 29 patients with electrical burns of extremities,16 cases had excellent and good joint function assessment,accounting for 55.2%;10 cases were moderate,accounting for 34.5%;and 3 cases were poor,accounting for 10.3%.The skin flap donor site has good appearance,mild scar hyperplasia,Vancouver Scar Scale score is 1-5(3.1±1.0).There was no significant difference in motor function between the two sides and complications such as muscle hernia and quadriceps dysfunction were found.ConclusionUsing the concept of donor site protection to cut free anterolateral thigh perforator flaps not only has a good clinical effect in the repair of electric burn wounds,and the donor area can be directly closed in the first stage to avoid the formation of skin graft and the second donor area,so as to achieve the effect of protecting the donor area.