Clinical curative effects of two types of pedicled flaps in repairing the full-thickness electric burn wounds deep to tendon and bone in the knee
Objective To compare the clinical curative effects of saphenous artery flap and retrograde anterolateral femoral perforator flap in repairing full-thickness electric burn wounds deep to tendon and bone in the knee.Methods This study was a retrospective observational study.From July 2018 to February 2022,34 patients with full-thickness electric burn wounds deep to tendon and bone in the knee and conformed to the inclusion criteria were admitted to Zhengzhou First People's Hospital,including 26 males and 8 females,aged 18 to 54 years.According to the repair method of the electric burn wounds in the knee,the patients were divided into saphenous artery flap group(18 cases)repaired with saphenous artery flap and anterolateral femoral flap group(16 cases)repaired with retrograde anterolateral femoral perforator flap.The exposed area of bone and/or tendon after debridement was 5 cm×4 cm to 12 cm×7 cm,5 patients were combined with open joint,and the resected area of the flap was 9 cm×6 cm to 25 cm×12 cm in saphenous artery flap group;the exposed area of bone and/or tendon after debridement was 7 cm×5 cm to 15 cm×7 cm,6 patients were combined with open joint,and the resected area of the flap was 15 cm× 10 cm to 39 cm×25 cm in anterolateral femoral flap group.According to the resected width of the flap,the wounds in the flap donor areas were repaired by direct suture or medium thickness skin graft in the trunk.The survival of the flap was observed after surgery.At the last follow-up,the color and texture of the flap were observed,and the two-point discrimination distance of the flap was detected.The sensory recovery of the flap was evaluated using the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association,and the excellent ratio of sensory recovery was calculated.The function of knee joint was assessed using the Knee Subjective Score Scale of International Knee Documentation Committee.The repairing effect of the flap was evaluated using comprehensive evaluation scale of flap,and the excellent ratio was calculated.Results Most of the flaps in patients in the 2 groups survived well after surgery,only 2 patients in the anterolateral femoral flap group had distal flap necrosis of 3 to 5 cm2,which healed after skin grafting or local suture.At the last follow-up of 12 to 18 months after surgery,the color and texture of the flap in patients in the two groups were similar to those of the skin tissue in the knee.The excellent ratio of sensory recovery of the flap was 18/18 in patients in saphenous artery flap group,which was significantly higher than 5/16 in anterolateral femoral flap group(P＜0.05).The two-point discrimination distance of the flap was(11.741.5)mm in patients in saphenous artery flap group,which was significantly shorter than(21.5±1.7)mm in anterolateral femoral flap group(t=-1.84,P＜0.05).The score of the knee joint function and the excellent ratio of the repairing effect of the flap had no statistically significant differences in patients in the two groups(P＞0.05).Conclusions The full-thickness electric burn wounds deep to tendon and bone in the knee can be repaired with saphenous artery flap and retrograde anterolateral femoral perforator flap.After being repaired with those two types of flaps,the function of the knee joint recovers well,while the sensory recovery is better after being repaired by the saphenous artery flap.
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