整张预成形皮片移植治疗严重手烧伤创面

目的探讨应用整张预成形中厚皮片移植修复手部深度烧伤创面。方法对4例4只手深度烧伤创面早期切／削痂后取模,依据模片大小及形状用手术刀在供皮区切取整张预成形中厚皮片,无需拼接一次修复创面。结果除个别植皮点状坏死外,余全部成活。经6个月～2年随访,手部外观及功能基本恢复。结论预成形皮片移植后,与创缘完全吻合,无拼接痕迹,远期瘢痕轻,手外观及功能恢复好,同时避免皮片浪费,是值得尝试的一种手术方法。     

休克期切削痂植皮修复手部深度烧伤

目的 报道手部深度烧伤休克期切削痂植皮的治疗结果。方法 对16例25只手采取休克期切削痂、中厚皮移植。结果 休克期切痂植皮减少了感染，皮片成活良好，愈合时间明显缩短，手的外形及功能恢复满意。结论 手部深度烧伤应尽早切削痂，积极消灭创面，对大面积烧伤，应优先实施手部切痂。     

手部烧伤后早期切削痂分区植皮促进功能恢复

目的：手部功能精细,烧伤后往往因瘢痕挛缩影响手的功能,以适当的措施早期修复手部烧伤创面非常重要,有利于手部功能的恢复和防止瘢痕挛缩。方法：早期切削痂以中厚皮片分区植皮修复手部深度烧伤创面。结果：取得了满意的效果。结论：早期切削痂分区植皮有利于手部深度烧伤后功能的恢复。     

手部烧伤后早期切削痂分区植皮促进功能恢复

目的：手部功能精细，烧伤后往往因瘢痕挛缩影响手的功能，以适当的措施早期修复手部烧伤创面非常重要，有利于手部功能的恢复和防止瘢痕挛缩。方法：早期切削友中厚皮片分区植皮修复手部深度烧伤创面。结果：取得了满意的效果。结论：早期切削痂分区植皮有利于手部深度烧伤后功能的恢复。     

大张自体中厚皮移植在手部深度烧伤治疗中的应用探讨

目的:探讨大张自体中厚皮移植对减轻深度手部烧伤患者畸形和提高患者生活质量的疗效。方法:55例75只手入院后采取创面局部外用抗菌药物,及时行环状焦痂切开减张术,烧伤后3～10天在麻醉下行手背、指背切、削痂大张中厚皮移植术,术后10天开始功能锻炼。结果:66只手皮片全部存活,6只手由于皮下积液有零星部分植皮坏死、后经换药等治疗治愈。3只手Ⅱ期植皮全部成活,术后2～3周观察手外形和功能取得良好的效果。结论:对手部深度烧伤早期切削痂+大张中厚皮片是恢复手功能的重要措施。     

保留变性真皮并移植大张自体皮修复手部深度烧伤的远期疗效观察

目的观察保留变性真皮并移植大张自体皮修复手部深度烧伤的远期疗效。方法对86例患者的152只深度烧伤手经削刮痂保留变性真皮后,行大张自体皮移植术。术后观察疗效并作随访,时间为3个月—3年,对手部皮肤的颜色、弹性、挛缩程度及功能进行评级。结果152只手中外观及功能优良者141只,占92.8%。结论保留变性真皮并移植大张自体皮修复手部深度烧伤,术后外观及功能恢复较好,是修复手部深度烧伤创面的较佳选择。     

156例手部深度烧伤的早期整形修复

目的探讨手部深度烧伤后早期整形修复的治疗方法及临床效果。方法1994年12月~2004年12月,收治手部深度烧伤156例(198手)患者。男119例155手,女37例43手。年龄21~52岁。深度105例121手,度51例77手。伤后24h内手术29例36手,1周内手术94例117手,3周内手术33例45手。患者均采用中厚皮片、全厚皮片植皮或皮瓣修复,术后进行早期功能锻炼。结果术后无并发症发生,创面期愈合,皮瓣及植皮均成活。供区期愈合。145手获随访6个月~5年。参考王澍寰(2002)手功能评价标准:优109手(75.2%),良18手(12.4%),中11手(7.6%),差7手(4.8%)。结论手部深度烧伤后宜早期行整形修复手术,可有效预防手部瘢痕形成,功能得到良好恢复。     

手部深度烧伤的临床治疗分析

目的 总结手部深度烧伤的临床治疗经验. 方法 46例54只深度烧伤手,其中深Ⅱ度烧伤30例33只手,Ⅲ度烧伤16例21只手.根据伤情不同,早期选择不同手术方式修复创面,术后早期进行功能锻炼. 结果 54只手的修复方式:中厚皮片移植33只手,异体脱细胞真皮与自体薄皮片复合移植12只手,腹部带蒂皮瓣1只手,前臂骨问背动脉逆行皮瓣3只手,股前外侧皮瓣5只手.治疗后,51只手移植皮片、皮瓣均成活,仅3只手移植皮片后有局灶性坏死,创面得到有效覆盖.按关节活动范围( range of motion,ROM)评定,本组优31只手(57.4％),良17只手(31.5％),中4只手(7.4％),差2只手(3.7％). 结论 手部深度烧伤后,选择合适术式,早期手术修复创面及功能锻炼,可取得很好的疗效.     

手深度烧伤早期复合皮移植效果观察

手部深度烧伤，尽快消灭创面是保存患者手功能的根本措施。2003年6月～2005年12月，我们对手部深度烧伤采用早期切削痂移植复合皮的治疗方法，效果良好。报告如下。     

刃厚头皮皮片移植联合弹力套压迫治疗特重度烧伤患者手背部深度烧伤的临床观察

目的：探讨特重度烧伤患者在身体无法提供大片中厚皮片或全厚皮片时用刃厚头皮皮片移植联合弹力套压迫治疗手背部深度烧伤的疗效。方法：选择近8年笔者科室收治的6例特重度烧伤伴手背部深度烧伤的患者为研究对象，患者烧伤面积均大于80%，采用早期切削痂移植刃厚头皮并在植皮成活后尽早戴弹力套压迫术区或全手部，术后随访3～32个月，观察患者手部疗效。结果：6例患者中1例患者手部因削痂后基底血供较差导致植皮成活率较低，待创面肉芽组织生长再次植皮治疗后创面愈合，创面瘢痕增生较明显；其他5例患者手部均植皮成活良好，瘢痕增生不明显，远期随诊手功能无明显障碍。结论：对于身体无法提供大片中厚或全厚皮片的特重度烧伤患者，早期使用刃厚头皮皮片移植联合弹力套压迫治疗手背部深度烧伤，是简单有效的治疗方法，可以取得良好的远期效果。     

前臂骨间背侧动脉逆行脂肪筋膜瓣联合皮片移植修复手背缺损创面

目的 探讨前臂骨间背侧动脉逆行脂肪筋膜瓣联合皮片移植修复手背缺损创面的临床疗效.方法 应用前臂骨间背侧动脉逆行脂肪筋膜瓣联合皮片移植修复14例手背部缺损创面患者.术前进行脂肪筋膜瓣设计,脂肪筋膜瓣切取面积8 cm×6 cm~12 cm×9 cm,覆盖创面后在脂肪筋膜瓣表面加皮片移植.结果 14例脂肪筋膜瓣及移植皮片全部成活.患者均获随访,时间4～10个月.脂肪筋膜瓣色泽、质地、弹性均良好,无臃肿,无前臂骨间背侧神经损伤,患者功能恢复较满意.结论 前臂骨间背侧动脉逆行脂肪筋膜瓣联合植皮是修复手背部创面缺损的有效方法.     

Palmare Verbrennung der Hand

BACKGROUND: The purpose of this study was to evaluate the results of conservative and operative treatment for burn injuries in the palmar region of the hand. METHODS AND CLINICAL MATERIAL: One hundred ten patients from the severe burn center in Ludwigshafen, Germany were evaluated a mean of 28 months postoperatively. Sixty-one had been treated with split-thickness skin grafts (43 sheet and 18 mesh grafts). In addition to subjective evaluation (including pain assessment and aesthetic outcome rating by visual analog scale), objective outcome analysis included clinical tests, measurement of active range of motion and grip strength, and sensibility testing with the two-point discrimination and Semmes-Weinstein monofilament tests. RESULTS: Of the patients, 90% were satisfied with the results, showing excellent pain relief with an average score under 13 on the visual analog scale. Aesthetic outcome was rated good with sheet grafts; in appearance, mesh grafts tended to be rated average or insufficient. Functional outcome tests demonstrated a significant correlation between depth of injury and range of motion. Grip strength analysis revealed superior results with sheet grafts. Sensibility in the injured areas was lower than on the contralateral hands. The Semmes-Weinstein test average was 3.4 degrees at the burned area vs 3.0 degrees in healthy hands, underscoring lower sensibility after burns. CONCLUSION: Surgical treatment of burned palms leads to good subjective and objective results, if specialized burn units are involved. Overall sheet transplantation seems to be the better choice for surgical reconstruction of the palmar burned hand.     

依创面定形厚断层皮片在全手背瘢痕整复中的应用

目的:研究皮肤移植重建手背的理想整形方法。方法:选择38例41只手背瘢痕。在局部肿胀麻醉下全层切除手背瘢痕并作关节畸形复位。用布片制作与创面相同形状和大小的取皮模板,以此制作定形厚断层皮片,植至手背创面。结果:41个定形皮片中36个皮片完全成活,术后6￣28个月随访28例31只手,手外形及功能良好,皮片色泽接近正常皮肤,无环形瘢痕形成。5个皮片有点状皮片坏死,后期随访结果也较好。所有病例未发生明显的环形瘢痕。结论:定形厚断层皮片移植是手背瘢痕整形的理想方法。     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.

Abstract：

Objective To investigate a new method for correction of claw hand deformity after burns. Methods From May 2006 to Jul. 2010, 12 patients with claw hands deformities after burns were treated with skin grafts (11 hands) and skin flap(1 hand) with unsatisfactory results. Then elastic traction (skin traction or skeletal traction) were performed with individual functional brace. Results All patients were followed up for 0. 5 to 2 years. Elastic traction was effective in the correction of metacarpophalangeal joint deformity, buttonhole deformity, thumb-in-palm deformity, scar contracture, and palmar arch deformity. Conclusions Elastic traction is a simple and effective way for the correction of claw hand deformity after burns with less morbidity and stable results.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

The burned hand. A computer-assisted study of late function of 67 burned and operated hands

A good functional outcome of the hand is important in the rehabilitation of severely burned patients. The aim of the study was to evaluate the late functional outcome of deeply burned hands using a computer aided system and to correlate the function with the distribution of the hand burns. Over a 12-year-period 378 patients whose acutely burned hands had been operated on at the burn center of the university hospital Aachen were invited to a follow-up examination. 67 burned and operated hands were evaluated 57 (3-364) months after the burn by the computerized evaluation system EVAL. Active flexion and extension, grip strength, pinch (key, 3-tip and 2-tip), moving 2-point sensitivity and the pattern of skin grafts and scars were assessed. The use of the hand in daily activities was evaluated by a questionnaire. The hands were classified in 4 groups according to the burn pattern: I: patchy burns (total < 12 cm2), II: confluent dorsal burns, III: confluent palmar burns, IV: mutilating burns. Good results were found in group I (n = 25), comparable to normal hand function. In group II (n = 25) there was a significant loss of total active flexion with preserved strength. Increased extension lag and impaired grip strength characterized group III (n = 8). Late functional results in group IV (n = 9) depended on the reconstructive procedure. Between the 4 groups there were significant differences in function. The results were well correlated to the burn pattern and its extent according the classification.     

A rare case of congenital nasal and upper lip deficiency associated with multiple other malformations

Summary A child born in 1948 with rare multiple deformities first underwent operative correction of polysyndactyly of both hands at the age of 6 years. Before the beginning of puberty, treatment of the microcheilia and microrhinia was initiated. Multiple operations to lengthen the columella and the lateral nasal walls with rib- and auricular cartilage grafts, composite skincartilage grafts and skin flaps supported by cartilage grafts were necessary to obtain an harmonious aspect of the nose and the upper lip. Operative treatment of the other deformities was undertaken in the meantime.     

Renal transplantation in diabetic patients with or without simultaneous pancreatic transplantation 1986: data from the EDTA Registry

This report summarises the outcome of 90 combined kidney/pancreatic grafts performed in Europe in 1986. Data for the combined kidney/pancreas grafts were obtained by a special questionnaire. The one-year patient and kidney graft survival is compared to the results of a group of 389 patients with diabetic nephropathy on the EDTA Registry data file who received kidney grafts alone. The recipients of combined kidney-pancreas grafts were younger, whereas a greater proportion of males received kidney graft alone. Patient survival at one year after transplantation was similar: 89% in recipients of combined transplants compared to 90% in recipients of kidney grafts alone. Kidney graft survival was 78% at one year for recipients of combined grafts versus 76%. It is concluded that pancreas transplantation has little effect on the fate of concomitant kidney grafts. The procedure should-in experienced hands and in selected patients-be almost as safe as kidney grafting alone.