The electrician was injured by high-voltage electricity, and after treatment, he recovered his life, and the doctor also skillfully applied "flower transfer" to repair the huge defect in the scalp

Jimu news reporter Zheng Jingjing

Correspondent Tian Juan Qi Jiandong

Mr. Liu, an electrician, was recently injured by a high-voltage electric shock and his life was hanging in the balance. After being sent to Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Mr. Liu escaped death after multidisciplinary cooperation between trauma surgery, maxillofacial surgery, anesthesiology and nursing department of Stomatology Center. Experts also skillfully applied "flower transfer", and successfully performed skin transplantation for him to repair scalp defects. On August 2, the Jimu News reporter learned that At present, Mr. Liu is recovering smoothly and can be discharged from the hospital immediately.

The doctor is making an round for Mr. Liu

On May 26, Mr. Liu (pseudonym), a 57-year-old electrician, was unexpectedly hit by a 10,000-volt high-voltage electric shock while performing his work, and his right limb and scalp were injured and turned black, and he was sent to a local hospital for rescue by his co-workers. When he was admitted to the hospital, Mr. Liu suffered severe pain from multiple burns all over his body, his head and right upper limb, and his head and chest CT showed parietal fractures, right parietal lobe bleeding, cranial plate gas, subarachnoid hemorrhage, and right pleural effusion, and his condition was very serious.

Gao Wei, deputy chief physician of the Department of Trauma Surgery of Tongji Hospital, said that after Mr. Liu was injured by high voltage electric shock, the surface of the skin seemed to be small, but in fact, the deep tissue of the skin was seriously damaged. During the treatment, he continued to have fever, necrosis at the end of his right limb, large necrosis of the scalp, and a large amount of necrotic fluid flowing out. During this period, the trauma surgery team performed 5 debridements, drainage and 2 amputations on Mr. Liu's exposed wounds. Fortunately, Mr. Liu saved his life. However, due to the electric shock injury, Mr. Liu's scalp necrosis defect area is huge, and it is "imminent" to repair the head skin defect.

Professor Tao Xuejin, medical director of the Stomatology Center of Tongji Hospital, said that the high-voltage electrical injury caused a large-scale electric burn on Mr. Liu's scalp, with a defect area of 27×19 cm, which was much larger than the area of the palms of two adults. Long-term skull exposure increases the risk of reinfection, and although it is temporarily protected by negative pressure closed drainage technology, it is by no means a long-term solution. If parts of the necrotic and exposed skull are not treated in time, the patient's life is in danger. In recent years, the Oral Medicine Center of Tongji Hospital has done flap repair surgery in many parts of the human body, "from head to toe." After seeing Mr. Liu's condition, Professor Tao Xuejin confidently said: "Such a difficult and huge defect repair, we have a way to deal with it." ”

Professor Tao Xuejin introduced that according to the traditional repair method, there are two ways to treat such scalp defects: First, free skin grafting, take the skin on the stomach and transplant it to the skull, this free skin graft requires the bare skull surface to be healthy, but Mr. Liu's skull is scorched black, and the free skin graft is basically unable to survive. The second is to implant a scalp dilator under the scalp, and after the scalp is expanded, it will be transferred to the bare bone area. However, for Mr. Liu, who has a huge loss of head skin area, there is less scalp available for expansion, and even if the implantation is successful, the dilator cannot be fixed, so this method is not feasible. In addition, just as planting crops requires land, the success of skin transplantation requires granulation as the base layer, and high-pressure burns directly hurt the lowest skull, and the granulation tissue cannot be regenerated, so even if the skin expansion surgery is successful, it is difficult for the transplanted skin to survive. Moreover, such a large area of autologous skin grafting requires the insertion of the dilator in advance, and it is impossible to "expand" multiple times without two or three months, and for Mr. Liu, the waiting interval for surgery is too long.

After careful study and repeated discussions, Professor Tao Xuejin's team of oral and maxillofacial surgery finally decided to use bilateral free flaps on the lateral thighs to repair scalp defects at one time and reduce the risk of multiple surgeries. On July 12, everything was ready and the surgery officially began. Under the arrangement of Professor Tao Xuejin, first of all, Dr. Hu Chuanyu and Dr. Huang Chunming simultaneously prepared a 9×25 cm flap from the root to the groin area on Mr. Liu's left and right thighs. Due to this accidental injury, Mr. Liu was bedridden for a long time, with weight loss, leg muscle atrophy, loose skin, and the flap could be directly sutured after removal. In the second step, the transplanted flap is microassemounded with the extramaxillary arteries and veins of the neck and the superior thyroid arteries and veins under the microscope. In the third step, further debridement is followed by the surgical protocol discussed, and part of the fat on the flap is removed, avoiding excessive "bloating" of the grafted skin, while reducing the liquefaction of adipose tissue after inactivation, thereby reducing the risk of infection. Finally, the two flaps were sutured and trimmed with the normal wound of the head to restore the shape and function of the patient's head to the greatest extent. Then through the acupuncture experiment, the blood circulation is observed to ensure that the flap is alive.

Professor Tao Xuejin introduced that such a large area of flap transplantation, it is not enough to fix the flap through external sutures, and how to perfectly chimerize with the skull in the middle and bottom of the flap is also an unprecedented problem. Gao Wei, deputy chief physician of trauma surgery, innovatively proposed that by making multiple small holes in the skull, the flap tissue "grows" into the small hole in the skull, and the growth of internal and external granulation buds is like a "rivet", which can make the flap "fixed". Nearly 8 hours of surgery, the doctor most of the time to maintain the same posture, under the microscope breath-holding, patient and meticulous operation, like embroidery of the 5 fragile blood vessels stitched up little by little, the operation was successfully completed.

On August 2, the Jimu News reporter learned that Mr. Liu is currently recovering smoothly and can be discharged from the hospital immediately.

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