敷料包扎塑形法在儿童手足畸形整复术后的应用  

A new wound dressing without regular change in surgical treatment for congenital hand or foot deformities

作　　者：肖军[1] 田晓菲[1] 邱林 傅跃先[1] 杨光 Xiao Jun;Tian Xiaofei;Qiu Lin;Fu Yuexian;Yang Guang(Department of Burns and Plastic Surgery,Children’s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院烧伤整形科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,400014

出　　处：《中华整形外科杂志》2021年第12期1350-1355,共6页Chinese Journal of Plastic Surgery

摘　　要：目的介绍儿童手足畸形术后采用敷料包扎塑形,达到手术部位关节塑形、制动、减少换药次数目的的方法,并讨论其注意事项和优点。方法对在重庆医科大学附属儿童医院进行手术治疗,并于2019年1至12月在门诊换药随访的手足畸形患儿资料进行回顾性总结。术后切口外涂莫匹罗星软膏,采用防粘连敷料、无菌纱布及绷带、粘性胶带分层包扎,并通过敷料堆积的厚薄以及绷带缠绕的方向使关节固定于术者需要的位置,必要时外层加用小夹板制动,指(趾)顶端预留观察窗。术后观察指(趾)血运,48 h无异常时封闭观察窗。包扎无渗液、无异味、未被液体污染者,术后2~4周拆包扎或首次换药。患儿门诊来访时观察并记录创面愈合情况。结果共纳入436例患儿,其中男256例,女180例,手术年龄5个月~6岁,平均2.6岁;并指(趾)畸形166例,多指(趾)畸形213例,手足部瘢痕挛缩22例,其他手足部畸形35例;均为腕关节、踝关节以远部位的无菌手术。首次拆开包扎的时间为术后6~33 d,平均21.3 d。切口甲级愈合431例(98.9%),乙级愈合1例(0.2%),丙级愈合4例(0.9%),均经常规换药后愈合。结论在保证严格无菌操作的情况下,儿童手足畸形整复术后采用敷料包扎塑形法可达到替代石膏或支具维持手足部位关节塑形、严格制动的目的,减少换药甚至不换药,更有利于骨关节的愈合,减少或免去儿童换药的痛苦,包扎轻巧更方便家长护理。此方法安全可靠,舒适性好,适用于儿童。Objective To introduce a new wound dressing method without regular dressing change after surgical treatment of hand or foot deformities for children,discuss the key points of application and advantages.Methods The data of patients with hand and foot deformities who received surgical treatment in Children’s Hospital of Chongqing Medical University from January to December 2019 were retrospectively summarized.After the operation,mupirocin ointment was applied outside the incision,and the layered dressing was used with antiadhesion dressing,sterile gauze and bandage,and adhesive tape.The joint was fixed to the position required by the thickness of the dressing accumulation and the direction of bandage winding.If necessary,a small splint was added to the outer layer,and an observation port was reserved at the top of the finger(toe).Blood supply of fingers(toes)was observed after the operation,and the observation port was closed without abnormal condition 48 h later.If there was no exudation,odor or liquid contamination,the dressing should be changed for the first 2-4 weeks after surgery.The wound healing was observed and recorded during the outpatient visit.Results A total of 436 patients were enrolled,including 256 males and 180 females.The operative age ranged from 5 months to 6 years old,with an average of 2.6 years.There were 166 cases of syndactyly,213 cases of polydactyly,22 cases of hand and foot scar contracture,and 35 cases of other hand and foot deformities.All the cases were aseptic operations on distal wrist and ankle joints.The first time to remove the dressing was 6-33 days after surgery,with an average of 21.3 days.Grade A healing was found in 431 cases(98.9%),grade B healing in 1 case(0.2%),and grade C healing in 4 cases(0.9%).All the incisions were healed by dressing change.Conclusions With strict aseptic manipulation,it is safe and reliable for children with hand or foot deformities to apply this dressing method without regular change following surgery.The method can satisfy the need for bone and

关 键 词：手畸形 足畸形 伤口愈合 儿童 换药 关节制动 

分 类 号：R726.2[医药卫生—儿科]