烧伤后爪形手畸形手术治疗体会  

Experience of surgical treatment of claw-hand deformity after burn injury

作　　者：郭智辉 张毓姣 GUO Zhi-hui;ZHANG Yu-jiao(Taiyuan Iron and Steel(Group)Co.,Ltd.General Hospital(Shanxi Province Burn Treatment Center),Taiyuan 030000,China)

机构地区：[1]太原钢铁(集团)有限公司总医院(山西省烧伤救治中心),030000

出　　处：《中国实用医药》2023年第6期50-52,共3页China Practical Medicine

摘　　要：目的 探讨烧伤后爪形手畸形手术治疗体会。方法 回顾性分析30例烧伤后爪形手畸形患者的临床资料,共有42只爪形手,所有患者均进行瘢痕切除后植皮或皮瓣修复治疗,分析治疗效果。结果 40只患手在移植后2周所有皮片全部成活;2只手腹部皮瓣转移后3周断蒂,皮瓣全部成活,3个月后进行分指手术。随访0.5~1.0年,6只手因指蹼粘连行指蹼切开全厚皮移植或五瓣法松解粘连指蹼,余手功能基本恢复,患手绝大部分关节畸形完全或基本纠正,效果较为满意。经腹部带蒂皮瓣修复的2只手功能基本正常,患者满意;其余患手的手功能基本恢复,皮片移植后质地与正常皮肤相近,部分伴色素沉着,缝线边缘瘢痕轻度增生。结论 烧伤后爪形手畸形的手术方案选择以大张自体中/全厚皮移植为主,若有肌腱、骨外露可考虑使用皮瓣修复创面,手术后进行早期功能康复锻炼,能促进患手的恢复。Objective To discuss the experience of surgical treatment of claw-hand deformity after burn injury.Methods The clinical data of 30 patients with claw-hand deformity after burn injury were retrospectively analyzed,including 42 claw hands.All patients were treated with skin grafting or flap repair after scar resection,and the therapeutic effect was analyzed.Results All the flaps survived 2 weeks after transplantation in 40 hands,2 hands were covered with abdominal pedicled skin flap,and 3 weeks later the pedicle was severed,3 months later the fingers were divided,and all flaps survived.At 0.5-1.0 years of follow-up,6 hands were treated with fullthickness skin grafting or five flaps due to the adhesion of webbed fingers.The function of the remaining hands was basically restored and most of the joint deformities of the affected hands were corrected completely or basically with satisfactory results.The function of 2 hands repaired by abdominal pedicle flap was normal and the patients were satisfied.The hand function of the other affected hands was basically recovered,and the texture of the skin grafts was similar to that of normal skin,some of them were accompanied by pigmentation and slight hyperplasia of suture edge scar.Conclusion The major surgical option for claw-hand deformity after burn injury is autogenous medium/full-thickness skin grafting.If the tendon or bone is exposed,the skin flap should be used to repair the wound.Early functional rehabilitation exercise after operation can promote the recovery of the affected hand.

关 键 词：手烧伤 爪形手畸形 植皮 带蒂皮瓣 

分 类 号：R658.2[医药卫生—外科学]