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病例男,12岁,颈部被380伏高压电击伤5 h 入院。创面22 cm×14 cm,上至项部发际,下抵胸1平面,两侧达胸锁乳突肌后缘,深达颈椎,颈4、5、6棘突外露。伤后7天行扩创右侧背阔肌肌皮瓣移转术,计划设计肌皮瓣18 cm×11 cm,剩余边缘创面以中厚皮移植,术后实际创面22 cm×15 cm,取右侧背阔肌肌皮瓣,血管蒂约2.5 cm。分离皮下隧道并将肌皮瓣试移转。因肩胛骨阻挡,旋转移位受限.颈项部创面覆盖不全。遂游离右侧肩胛骨,形成肩胛下隧道。肌皮瓣顺时针旋转115Ⅰ°,顺利通过隧道,覆盖创面。缝合固定,肌皮瓣下置负压引流管引流出少许血性液体,术后第12 h 发现肌皮瓣较肿胀及有散在瘀斑,16 h 出现静脉危象,立即拆开缝线探查,肌皮瓣下积血块约100 ml,肌皮瓣边缘仍有渗血,且有一条小肌支血管出血及部分创面渗血,因血块
Case male, 12 years old, neck was injured by high voltage electric shock of 380 V for 5 h. Wound 22 cm × 14 cm, up to the Department of hair, under the chest 1 plane, both sides of the posterior margin of the sternocleidomastoid, deep cervical spine, 4,5,6 spinous process exposed. Seven days after injury, the right latissimus dorsi muscle flap was transferred. The myocutaneous flap was designed to be 18 cm × 11 cm. The remaining marginal wounds were grafted with medium thickness skin. The actual wound area was 22 cm × 15 cm Right latissimus dorsi muscle flap, blood vessels about 2.5 cm. Separate the subcutaneous tunnel and transfer the myocutaneous flap. Blocked by the shoulder blades, rotational displacement is limited. Neck wound coverage incomplete. Then free the right shoulder blade to form a subscapular tunnel. Myocutaneous flap rotated 115 ° clockwise, through the tunnel, covering the wound. Sutured and fixed under the myocutaneous drainage tube drained a little bloody liquid, 12 h after operation myocutaneous flap was found to be more swollen and scattered ecchymosis, venous crisis occurred at 16 h, immediately opened the suture exploration, muscle Under the flap blood clots about 100 ml, myocutaneous flap is still bleeding edge, and there is a small muscle branch bleeding and some wound bleeding, due to blood clots