Objective:To investigate the clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist.Methods:A retrospective observational study method was used. From September 2016 to October 2021, thirteen male patients (aged 20-43 years) with annular high voltage (10-100 kV) electrical burns on the wrist were admitted to the Beijing Jishuitan Hospital. At the early stage after injury, the patient's wrist was subjected to incision, tension reduction and debridement, with the wound area after debridement being 27 cm×16 cm-32 cm×19 cm; in 12 patients with vascular injury, the radial or ulnar artery was reconstructed by great saphenous vein transplantation, with the length of 15-25 cm; the wrist wound was repaired by free transplantation of the deep inferior epigastric artery paraumbilical perforator flap (if the wound was giant, the lower abdominal flap carrying other perforators was used), with the area of 30 cm×19 cm-35 cm×20 cm. The donor site was repaired by direct suture+skin grafting or relay flap transplantation. After surgery, the survival of flap in recipient area, as well as survival of the skin or flap in donor site were observed. During follow-up, the appearances of the flap in recipient area and the recovery of hand function, as well as the healing of donor site, occurrence of abdominal wall hernia, and scar in skin graft area were observed.Results:After surgery, all the 13 patients' paraumbilical perforator flaps survived. Among them, 3 patients had subcutaneous fat necrosis at the distal end of the wrist flap, and the wound had mild infection, which healed after re-expansion and dressing change. All the skin grafts in the donor site of 10 patients survived, and the flaps in the donor site of 3 patients survived well. The patients were followed up for 6 months to 3 years. The flaps in recipient area were in good shape, 8 cases had partial recovery of hand function, and 5 cases had loss of finger flexion function; the donor site of abdominal flap healed well with no abdominal hernia occurred, and the skin graft site had no obvious scar hyperplasia and was soft in texture.Conclusions:Early vascular reconstruction after injury, together with free transplantation of the giant deep inferior epigastric artery paraumbilical perforator flap are effective in repairing circular high-voltage electrical burn wounds on the wrist.

Objective: To explore the excellent methods for aesthetic repair of the donor sites of flaps. Methods: From January 2013 to March 2018, 120 patients (94 males and 26 females, aged from 3 to 60 years) were admitted to the Department of Burns of Beijing Jishuitan Hospital. Wounds areas after debridement or removing scar were ranged from 8.0 cm×3.5 cm to 24.0 cm×18.0 cm. Twenty patients with facial and neck scar were repaired with expanded flaps, including 4 scalp flaps, 8 supraclavicular flaps, 4 deltoid flaps, and 4 trapezius myocutaneous flaps. The flaps in ideal donor sites were selected to repair the wounds in 40 patients, including 20 cases of hand wounds or scars repaired with inguinal flaps, 10 children of foot skin defects or scars repaired with cross inguinal skin flap, 10 cases of knee joint wounds repaired with medial or lateral thigh flaps. The optimal flap design was used to repair wounds in 50 patients. Among the patients, wounds of 36 patients were repaired with relaying flaps, including donor sites of free anterolateral thigh flaps of 8 patients repaired with anteromedial thigh perforator flaps and donor sites of free anterolateral thigh flaps of 8 patients repaired with ilioinguinal flaps or superficial abdominal artery flaps, and donor sites of flaps of 20 patients repaired with peroneal perforator relaying flaps. Besides, wounds of 9 patients were repaired with free lobulated anterolateral thigh flaps, and wounds of 5 patients were repaired with modified V-Y propelling latissimus dorsi myocutaneous flaps. The donor sites of flaps were repaired with allogenic acellular dermal matrix combined with autologous split-thickness skin grafts in 10 cases. The areas of the flaps or myocutaneous flaps were ranged from 6.0 cm×4.0 cm to 30.0 cm×20.0 cm. The survival of flap, myocutaneous flap, or skin graft and the repair of donor site after operation and during follow-up were observed. Results: Blood flow obstacle at 0.5 cm to the distal margin of the flap occurred in 1 patient repaired with expanded flap, which were healed after dressing change. Blood supply disorder occurred at the tip of the anteromedial thigh perforator flap of 1 patient repaired by optimal flap design, which were healed completely after second debridement and restitching. The other flaps or myocutaneous flaps survived well. The allogenic acellular dermal matrix and the autologous split-thickness skin graft survived with good color and texture. During follow-up of 3 months to 4 years, the donor sites of flaps had good appearance, only with linear scar and the function recovered well. The donor sites of skin grafts had no scar hyperplasia, only with scattered pigmentation. Conclusions According to the characteristics of donor sites of flaps, individualized and reasonable design before the operation such as pre-expanding of the flaps, selecting the ideal donor sites, optimization of the flap design or allogenic acellular dermal matrix combined with autologous split-thickness skin graft to repair donor sites of flaps can minimize the damage for function and appearance of donor sites of flaps and achieve aesthetic effects of donor sites of flaps.

Salt reduction is the most cost-effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24-h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24-h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Objective: To explore the clinical effects of perforator flaps in the reconstruction of hypertrophic scar contracture deformities in the large joints of extremities after severe burns. Methods: From January 2008 to January 2018, 72 patients (53 males and 19 females, aged 5 to 63 years) with hypertrophic scar contracture deformities and functional disorder in the large joints of extremities after severe burns were admitted to the Department of Burns of Beijing Jishuitan Hospital. Scar hyperplasia and contracture deformity were located at shoulder joints of 28 patients, elbow joints of 15 patients, hip joints of 7 patients, knee joints of 17 patients, and ankle joints of 5 patients. The wound area of patients after the scars were excised and released ranged from 7 cm×6 cm to 34 cm×12 cm. The wounds were repaired with corresponding unexpanded perforator flaps or expanded perforator flaps according to the joint location and existing soft tissue conditions. The size of flaps ranged from 7 cm×6 cm to 35 cm×14 cm. The donor sites of 51 patients were sutured directly; the donor sites of 21 patients were repaired by segmented grafts or mesh grafts. The adopted surgeries, the survival of flaps after surgery, and the functional recovery of the joints during follow-up were recorded. Results: Among the 72 patients, 53 patients had perforator flap repairing surgery only; 19 patients had perforator flap repairing surgery and skin grafting. Among them, 12 patients had expanded perforator flaps, 60 patients had unexpanded perforator flaps. The perforator flaps were performed free transplantation in 9 patients, pedicled transplantation in 61 patients, and groin transplantation in 2 patients. At last, 67 flaps survived completely, while 5 flaps had distal-end necrosis which were healed after dressing change or skin grafting after debridement. During follow-up of 6 months to 3 years, the joint function of all the patients was obviously improved. The abduction angles of shoulder joints were over 110°; the hip, knee, and elbow joints could reach the straight position, and the flexion was normal; the foot drop deformity was corrected, and the appearance of flaps was good with obvious extension compared with the original state. Conclusions Perforator flaps are suitable for reconstruction of hypertrophic scar contracture deformities in the large joints of extremities of patients after severe burns. They can restore the joint function to the greatest extent as well as repair the wounds.

Objective: To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. Methods: From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded. Results: All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function. Conclusions Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

Salt reduction is the most cost?effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24?h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24?h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Salt reduction is the most cost?effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24?h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24?h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Objective: To study the outcome of perforator flap combined with mesh in repairing cicatricial abdominal hernia after deep burn. Methods: From June 2000 to June 2016, 11 cases of cicatricial abdominal wall hernia after deep burn were treated. 8 cases were caused by electrical burn, 2 cases by stove burn and 1 case by molten iron burn. All of them were Ⅳ degree burn of abdominal wall. The overall treatment time was 1-11 years, with the average of 4.1 years. The hernias were 6 cm × 6 cm to 12 cm × 11 cm in size. The abdominal wall hernia was repaired following the process of scar excision, mesh and perforator flap transfer and defect repairment. 3 kinds of mesh materials were used, polypropylene mesh (n=7), composite mesh (n=2), and acellular allogenic dermis (n=2). The size of meshes ranged from 8 cm ×8 cm to 16 cm ×13 cm. Meanwhile, paraumbilical perforator flaps were used in 5 patients, and anterolateral thigh perforator flaps were 6. The flaps were 18 cm ×10 cm to 22 cm ×13 cm in size. Results: All 11 cases of abdominal wall hernia were repaired. Follow-up period was 6 months to 2 years. There was no recurrence was found. The shape of the flap was satisfying. Conclusions The perforator flap combined with mesh is a good method to repair cicatricial abdominal wall hernia after deep burn.

Objective To investigate the clinical application and effect of pick-stab skill in eyebrow embroidery.Methods From July 2015 to January 2016,36 cases were selected to receive eyebrow embroidery with pick-stab skill in our department,including 1 male and 35 females.The cosmetic outcomes,complications and satisfaction rate were observed in these cases.Results In these 36 cases,14 cases were colored in one time,19 cases were colored twice,and 3 cases were more than 3 times.All patients were followed up for 6 months.The color of the eyebrow was natural,and the blue color was not existed.Conclusions The pick-stab skill in eyebrow embroidery is worthy in clinic with better cosmetic effect,higher success rate and safety.

Objective: To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. Methods: From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients′ general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. Results: The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. Conclusions The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.