腕部电烧伤二期肌腱移植重建手部功能的临床疗效分析OA

Objective To investigate the clinical outcomes of secondary tendon grafting for hand func-tion reconstruction following successful free flap coverage in patients with type Ⅱ and Ⅲ electrical burns to the wrist.Methods A retrospective analysis was conducted on 20 patients with type Ⅱ and Ⅲ electrical burns to the wrist who were treated in our department from January 2020 to June 2025,including 12 cases of type Ⅱand 8 cases of type Ⅲ.The cohort included 13 right-sided and 7 left-sided injuries;17 cases of high-voltage and 3 cases of low-voltage electrical burns.Both radial and ulnar arteries were disrupted in 5 patients,while at least one artery remained patent in 15 patients.The time from injury to admission ranged from 4 hours to 37 days.All patients underwent successful primary wound coverage with free flaps followed by secondary tendon grafting for hand function reconstruction.Injury characteristics,tendon defect length,graft materials,surgical tech-niques,and postoperative rehabilitation were recorded.Hand function recovery was assessed using the Quick-DASH score at the final follow-up,and sensory function was evaluated in the 4 patients who underwent nerve grafting using the British Medical Research Council(BMRC)grading system.Results All primary free flaps survived successfully in all 20 patients.Secondary functional reconstruction was performed at 3 to 10 months post-injury(mean 6.15 months).All 20 patients underwent tendon grafting.Tendon defect lengths ranged from 6 to26 cm.A total of 57 tendons were used,including45(78.9%)allogeneic tendons and12(21.1%)autolo-gous tendons.Postoperatively,14 patients(70%)underwent tenolysis due to adhesion,3(15%)underwent tendon shortening,and 2(10%)underwent tendon repair due to rupture.Additional procedures included thumb opposition reconstruction in3 patients(15%),sural nerve grafting in 4 patients(20%),metacarpo-phalangeal joint volar plate plication in4 patients(20%),and scar release in7 patients(35%).The number of surgeries per patient ranged from1 to 6.Follow-up duration ranged from6 to 48 months(median 18 months).The median QuickDASH score at final follow-up was 26(range 11 to 45).Sensory recovery was unsatisfactory in the 4 patients who underwent nerve grafting,with two-point discrimination>15 mm,indicating S2 to S3 level nerve function recovery.Conclusions Secondary tendon grafting is an effective approach for restoring hand function after electrical burns to the wrist,but it requires successful primary wound coverage with free flaps.Functional reconstruction necessitates sequential multiple surgeries,emphasizing systematic treatment and active patient cooperation.For eligible patients,secondary functional reconstruction should be considered a core component of the overall treatment strategy.