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目的探寻肢体热压伤合并主干血管损伤的治疗方案。方法对8例上肢严重热压伤合并骨筋膜室综合征患者实施减压术,但对肢体血运的改善不明显。行血管探查得知患肢均合并肱、桡、尺动脉或掌深、浅弓损伤,采用直接吻合、屈曲肢体吻合、大隐静脉移植等方式修复血管并移植中厚皮片或带蒂胸脐皮瓣封闭创面。结果1例肱动脉修复后创面植中厚皮片者因无良好的软组织覆盖,术后4周血管再度栓塞导致上臂中段截肢。7例血管修复后创面移植皮瓣的患者肢体血供完全恢复并得以完整保留。结论及时行血管探查和修复以及选择周围良好的软组织覆盖,是治疗热压伤合并主干血管损伤的关键措施。
Objective To explore the treatment of limbs with thermal injury and vascular injury. Methods Eight patients with severe hot crush of upper extremity and osteofascial compartment syndrome were treated with decompression, but the improvement of limb blood flow was not obvious. The vascular exploration revealed that the limbs were combined with the brachial, radial, ulnar artery or palm deep and shallow arch injury, using direct anastomosis, flexion limb anastomosis, saphenous vein transplantation and other ways to repair blood vessels and transplanting medium thick skin or chest thorax Flap closed wounds. Results 1 case of brachial artery wound repair thick skin flap due to no good soft tissue coverage, 4 weeks after the re-embolization of blood vessels leading to the middle of the upper limb amputation. The blood supply of the limbs of 7 patients who underwent wound repair after vascular repair completely recovered and was completely preserved. Conclusions Timely vascular exploration and repair as well as the selection of good surrounding soft tissue coverage are key measures for the treatment of hot crush injury associated with primary vascular injury.