成批危重烧伤患者面部和手部等关节部位创面的早期处理  

Early repair and reconstruction for the wounds of face and joints of mass burn casualties

作　　者：宋慧锋[1] 柴家科[1] 京萨[1] 柳春明[1] 杨红明[1] 贾晓明[1] 李利根[1] 贾赤宇[1] 许明火[1] 郝岱峰[1] 

机构地区：[1]解放军总医院第一附属医院烧伤研究所,北京100037

出　　处：《解放军医学杂志》2007年第12期1222-1223,共2页Medical Journal of Chinese People's Liberation Army

基　　金：全军"十一五"医药卫生科研基金专项项目(06Z054)

摘　　要：目的探讨应用整形美容原则和技术早期处理成批危重烧伤患者颜面部和手部等关节部位的深度创面,兼顾功能和外观修复的方法。方法23例重度烧伤患者均为男性,年龄24.4±6.3(17～46)岁,为深Ⅱ～Ⅳ度烧伤,总面积15.7%±13.9%(6%～75%)TBSA,均伴中度或重度吸入性损伤。23例中气管切开14例;伴少尿性肾功能不全1例;面部严重烧伤12例,为深Ⅱ～Ⅳ度烧伤,面积0.5%～3%TBSA;手部严重烧伤20例(计39只手),为深Ⅱ～Ⅳ度烧伤,面积1%～4%TBSA。伤后3天,应用整形美容的原则和技术行手部切(削)痂、自体中厚皮片移植;伤后2～3周,行面部剥痂、自体中厚皮分区移植术。结果所有患者颜面部和手部皮片成活良好,面部重要器官和手部的功能及外形满意。结论对成批危重烧伤患者在抢救生命的同时,应用美容和整形的原则和技术,早期处理颜面、关节等功能部位的创面是可行的。Objective To repair and reconstruct severe burn wounds on face,hands and joints with the principles and techniques of plastic and aesthetic surgery.Methods Twenty three burn victims in a single batch were transferred from a remote area to our Burns Institute on post burn day 2,June 28,2006.All the patients were males aged from 17 to 46 years,with a mean of 24.4±6.3 years,the mean total burn area was 15.7%±13.9% TBSA（ranged from 6% to 75%）,with moderate to severe inhalation injury,and fourteen of them had received tracheostomy.The burn areas on face ranged from 0.5% to 3% TBSA,and all of them were deep second or third degree burn.The burn areas on hands ranged from 1% to 4% TBSA of deep second or third degree.On post burn day 3,the patients received escharectomy or tangential excision of eschar on hands followed by split thickness skin grafting with the principles and techniques of plastic and aesthetic surgery.During post burn week 2 to 3,the eschar on the faces were peeled off,followed by split-thickness skin grafting according to the principles and techniques of plastic and aesthetic surgery.Results All the wounds on the face and joints were repaired successfully,the configuration and functions were satisfactory.Conclusion It is feasible to repair the burn wounds on face and joints with the principles and techniques of plastic and aesthetic surgery for the burn patients of mass fire catastrophe.

关 键 词：烧伤 面部 关节 修复外科手术 成批 

分 类 号：R644[医药卫生—外科学]