Electrical injury of wrist: classification and treatment--clinical analysis of 90 cases.

Between January 1980 and December 1989, a prospective study was carried out on 114 upper limbs in 90 patients, which were electrically burned with the wrist as the current entrance site. Based upon extensive clinical investigations of arterial injury and its adverse effect on hand circulation, a grading system is suggested for electrically injured wrists based on the severity of injury. The total amputation rate was 39.4 per cent in this group, which was composed of miscellaneous cases with various injuries. However, in subgroups of Type I to Type IV, the amputation rates were 0, 0, 80 and 100 per cent, respectively. A new method to repair the circumferential wound of an electrically burned wrist as well as to bypass the blood flow to the obstructed hand, using a pedicled greater omentum transfer and vascular anastomosis between gastroepiploic artery and the palmar artery, was successfully used in a Type III case.

[Functional recovery of tendons and nerves after early repair of electric burns of the extremities using cutaneous and myocutaneous flaps].

A new operative treatment for the early repair of electric burn injuries by using cutaneous or myocutaneous flaps are recommended. The functional results of the burnt tendons and nerves were followed up. 174 operations among 134 cases were performed from 1964 to 1984, amputation rate were decreased to 9.7%. The percentage of functional recovery of the burnt tendons at wrist canal are 97.6% and which of the 21 burnt peripheral nerves are 80.9%.

Microskin grafting in the treatment of extensive burns: a preliminary report.

Microskin grafting has proved to be an effective new procedure for the treatment of extensive burns, in which only a minimum amount of autogenous skin is needed for coverage of a large full-thickness burn wound. The technique has been improved and applied in 17 major burn patients. All patients survived. The wound covered with microskin grafts ranged from 6% to 45% TBSA, with a mean area of 24.1% TBSA. The expansion ratio of micrografts in this series reached up to 1:18, and can be greater. The wound healing was accomplished in three ways. 1) Wounds were completely resurfaced by micrografts in 24 limbs (58.5%). 2) Wounds were not totally healed with micrografts by the time the homograft was rejected, leaving only small raw areas which needed re-grafting in 12 limbs (29.3%). 3) The micrografts did not take on four limbs and one chest wall (12.2%). The improved technique, which has become more simple and feasible, is discussed in detail.

Microskin grafting. I. Animal experiments.

This article reports a new grafting technique--microskin grafting. These experiments were carried out in rabbits, and used a small amount of autograft minced into tiny pieces and then spread on a piece of homograft. The combined autograft plus homograft was then transplanted onto the wound of a rabbit. In 12 rabbits, the microskin grafts took well and covered the wound completely in 8 rabbits. The expansion ratios of the micrografts were from 7:1 to 15:1. The healing time of the wound was from 19 to 35 days. The operation failed in 4 rabbits because of the homograft moving. Histological sections revealed that microskin grafts orientated upwards can grow well and those orientated in a lateral or downward direction can grow too. This technique is an effective procedure for repairing extensive wounds with smaller donor sites.

Microskin grafting. II. Clinical report.

A technique for microskin grafting for treating extensively burned patients is presented. Eight extensively burned patients were treated in this way with encouraging results. The recipient area covered by microskin grafts ranged from 2.5 per cent to 44 per cent of the total body surface area (TBSA). The expansion ratio of the micrografts was 15:1 maximum. The micrografts took well in seven patients with the healing time ranging from 22 to 45 days post-operatively. One case failed because of sloughing of the homograft. The advantages of the microskin grafting are: (1) economical use of autografts, (2) the procedure is simple, (3) there is less scar on the recipient site. This new technique is effective, simple and feasible in extensive burns.