早期应用辐照氟银猪皮对浅Ⅱ度烧伤创面愈合作用的临床研究

目的探讨早期应用辐照氟银猪皮对浅Ⅱ度烧伤创面的愈合作用。方法对20例大面积浅Ⅱ度烧伤患者早期应用辐照氟银猪皮治疗,观察其对创面愈合作用的影响。结果所有病例创面均顺利愈合,创面平均愈合时间为（9.2±1.2）d,且愈合后色素沉着、瘢痕少,无一例发生感染,平稳度过休克期,均无局部刺激症状和过敏反应,肝、肾功能,血常规检查指标均正常。结论早期应用辐照氟银猪皮治疗大面积浅Ⅱ度烧伤创面愈合快,最大限度地保留创面再生能力,给创面愈合提供了良好的内环境。同时患者病情平稳、疼痛轻、瘢痕少,提高了生活质量。     

Cross-linked silver-impregnated skin for burn wound management

Biological skin is effective in restoring the missing water vapor barrier and promoting healing in burn wounds. Its effectiveness in wound management has been limited, however, by its inherently limited antibacterial properties and the fact that it is sometimes rejected before healing is complete, even reversing previous beneficial effects. Limited availability and storage difficulties have posed further problems. Impregnation of biological skin with silver ions has been proven to provide a potent bactericidal effect directly at the wound surface. We hypothesized that aldehyde cross-linking of silver-impregnated skin would mask the histocompatibility sites from the recipient's immune system. This has been demonstrated previously with aldehyde cross-linking of allografts and xenografts, prolonging retention sufficiently to permit complete wound healing. Commercially available skin was treated with an aldehyde compound and impregnated with silver. Initial studies of this cross-linked skin for treatment of burn wounds showed average retention to be between 117 and 161 days, far exceeding that of any untreated skin. It was subsequently found that the aldehyde cross-linking permitted impregnation with higher concentrations of silver than had previously been possible--2,600 to 2,830 ppm as compared to an average of 1,020 to 1,350 ppm in previously available silver-impregnated skin. This results in a more potent, immediate antibacterial effect at the wound surface and an extended period of time-release antibacterial action before the silver is exhausted. The antibacterial properties of this aldehyde cross-linked silver-impregnated skin are effective in decontaminating even grossly infected wounds and in protecting against contamination of clean wounds from adjacent infected areas or external sources.(ABSTRACT TRUNCATED AT 250 WORDS)     

泡沫敷料联合银敷料治疗糖尿病合并Ⅱ期压疮的疗效观察

目的:探讨泡沫敷料与银敷料联合治疗糖尿病合并Ⅱ期压疮的临床效果.方法:将78例符合2型糖尿病诊断标准、Ⅱ期压疮诊断标准的患者按入院先后顺序分为对照组、观察组各39例(98处).两组常规用生理盐水清洁伤口后蘸干,在此基础上,对照组内层敷料使用软聚硅硐泡沫敷料美皮康贴敷伤口,外层用美固固定.观察组内层敷料使用优拓S.S.D(主要成分为磺胺嘧啶银)贴敷伤口,中层敷料使用软聚硅硐泡沫敷料美皮康,外层用美固固定.分别观察两组治愈率、总有效率、换药次数、愈合时间及直接费用.结果:观察组治愈率、总有效率高于对照组;愈合时间、换药次数和直接费用低于对照组,且差异均有统计学意义(P＜0.05).结论:泡沫敷料联合银敷料治疗糖尿病合并Ⅱ期压疮可缩短创面愈合时间,减少换药次数和治疗费用,提高治愈率.     

The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns

Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98%+/-1% (mean +/- standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3+/-5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness skin permits the substitution of cadaveric allograft with Integra and the substitution of donor autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness skin autografts.     

Split skin graft application over an integrating, biodegradable temporizing polymer matrix: immediate and delayed

The objective of this study is to further investigate the NovoSorb? biodegradable polyurethane in generating dermal scaffolds; to perform a pilot study comparing the previously used spun mat against a recently developed NovoSorb? foam, ascertaining the optimum structure of the matrix; and to evaluate the successful matrix as an immediate adjunct to split skin grafting and as a temporizing matrix in a prospective six-pig study. A pilot study comparing a previously investigated form of the polymer (spun mat) against a new structural form, a foam, was performed. This was followed by a six-pig study of the foam matrix with three treatment arms-autologous split skin graft alone, polymer foam with immediate engraftment, and polymer foam with delayed engraftment. The foams allowed less wound contraction than the spun mats. The foam structure is less dense (cheaper to produce and having less degradation products). The material remained in situ despite clinical wound infection. Proof of concept was achieved in both treatment modalities in the main study. Split skin graft applied immediately over the polymer foam was able to engraft successfully. The result was "thicker" to pinch and "flush" with the skin surrounding the wound. There was no significant difference in the degree of wound contraction between the graft alone and the polymer plus immediate graft groups. Split skin graft also "took" when applied to the surface of a polymer that had been applied to a wound 11 days earlier, again with a thicker result, flush with the surrounding skin. Split skin grafts alone left a persisting depression. However, a significant degree of wound contraction (compared with the other two groups) was observed in the polymer plus delayed graft group. This has prompted further investigation into "sealing" the polymer foam with a membrane, to prevent evaporative water loss, when the foam is to be used as a biodegradable temporizing matrix. The studies indicate that the NovoSorb? platform will allow the creation of two inexpensive dermal matrix products; an immediate scaffold to allow a thicker grafting result and a biodegradable temporizing matrix (BTM) for wound integration after burn debridement while donor sites become reharvestable. However, further modification on the BTM structure is necessary to further reduce wound contraction pregrafting.     

Management of a circumferential lower extremity degloving injury with the use of vacuum-assisted closure

A 58-year-old male presented with a large circumferential degloving injury and was immediately taken to the operating room for further assessment of his wound. At that time, a plastic surgeon was consulted to manage the wound due to its size and significant soft tissue loss. The decision was made to manage the patient's wound with the vacuum-assisted closure (VAC) device to prepare the wound bed for grafting. After three weeks of VAC therapy, the wound bed was revascularized with granulation tissue and was ready for grafting. The patient underwent a successful split thickness skin graft on hospital Day 23 and was discharged home. Follow-up visits revealed no scar contracture or functional limitations.     

Burn therapy 1985: Acute management

Mortality occurs from a burn injury because of infections which result from the metabolic and bacterial consequences of a large open wound, depression of the host's resistance, and both protein and total caloric malnutrition. Systemic antibiotics, topical wound therapy, and gentle wound debridement constitute traditional burn therapy. The systemic antibiotics and topical wound therapy do not solve problems presented by large open wounds and the related protein and caloric deprivation. A more rational approach uses antibiotics and topical wound therapy only as adjuncts to a program of early operative removal or excision of the devitalized, burned tissue and immediate closure of the wound. The excised wound is normally closed with available autograft, but in massive burn injuries, donor skin is insufficient. In these massive injuries, artifical skin can provide that immediate wound closure. As long as devitalized, burned tissue remains present in the setting of depressed host resistance, cross infection tends to colonize those remaining devitalized burn wounds with more virulent organisms than those that were already present. Bacterial controlled nursing units (BCNU) provide strict protection against that cross infection. Though inevitably a catabolic response occurs with massive injury, intensive nutritional support provides the calories necessary for the response to injury to avoid a prolongation of that negative nitrogen balance.     

脱细胞异体真皮加自体薄皮复合移植减少瘢痕形成

BACKGROUND:Autogenous skin graft is a common method in treatment of deep burn,late survive effect of grafted skin flap is directly related to its thickness.In clinic,therapeutic effect of full thickness graft is the best.However,due to large skin providing area that can't be sutured directly and survive rate of graft at infected wound surface is very low,its clinical application is limited,especially in deep burn with large area.This study is to search a best material repairing wound surface of deep burn,reduce proliferation of scar and protect limbs function.     

皮瓣移植结合封闭式负压引流修复下肢皮肤及软组织缺损

背景：各种创伤引起的下肢皮肤及软组织缺损十分常见,常伴有严重的血运破坏和创面感染,患肢感染率高,不易愈合。目的：系统回顾关于下肢皮肤及软组织感染性缺损治疗的相关文献,结合华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损23例患者治疗效果,探讨皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损的适应症、方法及临床应用价值。方法：文章选取2004年8月至2011年11月在华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损患者共23例,男15例,女8例;年龄17-56岁,平均31.4岁。对23例下肢皮肤及软组织感染性缺损患者采用皮瓣移植结合负压封闭引流治疗,随访时间为4-15个月,平均7.3个月,观察临床效果。同时检索下肢皮肤及软组织感染性缺损治疗的相关文献,找出治疗对象相似、疗效评价标准相同的病例进行比较。结果与结论：23例下肢皮肤及软组织感染性缺损患者伤口感染菌中革兰阳性菌占52.2%,革兰阴性菌占47.8%,多重耐药菌占43.5%,应用封闭式负压吸引技术处理后,创面感染得到有效的控制,创面肉芽组织生长良好,通过皮瓣移植修复创面均痊愈。结果显示,皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损,可缩短创面愈合时间。     

Primary excision and immediate wound closure

Surgical principles of early excision of devitalized tissue and prompt wound closure which govern the management of all traumatic injuries have been developed in the primary treatment of burns. Topical and systemic antibiotics which delay wound infection and control invasive sepsis provide an initial period of two to three weeks in which wound excision and closure is safe and effective. Full support of the central and peripheral circulation, respiratory function, nutrition, and musculoskeletal function are essential features of care until the burn wound is eliminated and closed.Following initial evaluation, wound excision is carried beyond the deepest level of injured tissue. Excision to the level of muscle fascia is used for fullthickness injury and sequential excision in or below the dermis for deep dermal injury. Techniques of skin grafting and subsequent care of the graft are described, including the use of human allografts.Primary excision has reduced mortality, morbidity and later reconstructive measures by a factor of 50% when compared to results obtained by awaiting spontaneous separation of eschar with later grafting.With massive burns the use of allografts from familial donors of close immunologic type and immunosuppression of the patient prolong the period before allograft rejection and permit repeated harvest of the patient's donor sites for permanent wound closure. Over 60% of young burn victims with greater than 70% full-thickness burn injury have survived with this method of treatment.     

Infection control in severely burned patients

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.     

Vacuum-assisted closure use in calciphylaxis

Calciphylaxis-induced chronic wounds are difficult to heal. The value of vacuum-assisted closure (VAC) was assessed in two patients with calciphylaxis. Two middle-aged females with type 2 diabetes were transferred to the burn unit with a clinical diagnosis of necrotizing fasciitis, although the pathologic diagnosis was calciphylaxis. With extensive debridement, antibiotics, and meticulous wound care, one patient had progressive necrosis of her skin from 18 to 48% TBSA, whereas the other progressed from 5 to 10% TBSA only. The patient with the smaller chronic wound healed well and left the hospital at 72 days after admission. Although there was some success with the use of VAC, the patient with the extensive progressive wounds developed a fungal wound infection that did not respond to treatment; she died 78 days after initiation of burn center treatment. Some disadvantages to the usefulness would be extensive contiguous wounds and the lack of an intact skin surface. The VAC system was of value in healing wounds resulting from calciphylaxis.     

Comparison of a sealed, polymer foam biodegradable temporizing matrix against Integra? dermal regeneration template in a porcine wound model

The aim of this study is to develop and optimize the first stage of a proposed two-stage skin graft replacement strategy. This entails creation of a material that can be applied immediately after burn excision to "temporize" the wound bed, become integrated as a "neodermis," resist contraction and infection, and provide the grounding for the second stage (an autologous, cultured composite skin). Four 8 × 8 cm wounds were generated in six pigs to assess and compare wound contraction using Integra? dermal regeneration template, a biodegradable temporizing polymer matrix (sealed and unsealed), and a secondary intention wound. All dressings were contiguous. Infection resulted in early spontaneous delamination of the Integra? marring the long-term comparison. The wounds treated with the sealed polymer thus contracted significantly less than the wounds treated with Integra? over the 28 days. Histologically, a thick layer of scar developed superficial to the Integra?, unsealed polymer, and in the secondary intention wounds when compared with the sealed polymer, where such a scar layer was characteristically minimal. No clinical signs of infection were observed for any polymer-treated wound. Once the Integra? silicone layer delaminated, wound contraction was aggressive. Optimization of the biodegradable sealing membrane is imminent, and the second stage of composite skin development is under way.     

Application of split-thickness dermal grafts in deep partial- and full-thickness burns: a new source of auto-skin grafting

Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. Dermal graft take was complete in all but one patient. There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns.     

Immunosuppression of the burned patient

The burn patient is highly susceptible to infection due to the loss of the skin as a barrier to microorganisms. Immune defenses are activated in response to the burn injury; however, some of these defenses are altered. Neutrophil chemotaxis is compromised by decreased perfusion caused by hypovolemia and the formation of microthrombi. Chemotaxis and phagocytosis are dependent on complement components that are reduced in a large burn wound. Neutrophil intracellular killing power is reduced as oxygen delivery to the wound is decreased. Humoral immunity is altered with the drop in IgG levels. Cell-mediated immunity is depressed and T cell lymphocyte counts are deceased. Suppressor T cells are generated. Specific sources of infection for the burn patient include the patient's own bacterial flora; hospital personnel; respiratory equipment; and catheters, both urinary and intravascular. The best control for burn wound infection is the closure of the wound by early excision and grafting. When lack of donor sites prohibits this surgical therapy, control centers on the environment and wound care techniques. The selection of wound topical antibiotics on the basis of visual inspection and surface culturing assists in the prevention of burn wound sepsis. When wound sepsis does occur, systemic antibiotics are instituted. Although burn wound sepsis is an obvious cause of death for the burn patient, it is not the primary cause. Increasing sophistication in fluid resuscitation and in intensive care therapy has resulted in patients living beyond the initial insult and the following few days. Burn patient mortality is now associated with a syndrome presenting clinically as sepsis but without any identifiable septic source.(ABSTRACT TRUNCATED AT 250 WORDS)     

同种异体脱细胞真皮加自体刃厚皮片修复手部烧伤

目的 探讨同种异体真皮加自体刃厚皮片移植的临床应用,丰富手部严重烧伤的治疗。方法 2001-2005年采用同种异体真皮加自体刃厚皮片移植修复55个手部严重烧伤创面。结果 55个创面中,52个创面植皮完全成活,无瘢痕增生,没有刺痛,搔痒症状。只有3个创面出现散在点状坏死,经过2～3次换药愈合,有较明显的瘢痕。伤愈6-24个月获随诊11例13个创面：皮肤色素沉着基本如常,创缘无瘢痕增生,质地柔软,弹性良好,无挛缩。与自体全厚植皮无明显差异。结论 采用同种脱细胞真皮＋自体刃厚皮片移植修复手部严重烧伤,手术方法简便,疗效满意,没有排斥反应．是手部烧伤治疗的重要补充。     

Efficacy of topically delivered moxifloxacin against wound infection by Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus

Wound infection is a common risk for patients with chronic nonhealing wounds, causing high morbidity and mortality. Currently, systemic antibiotic treatment is the therapy of choice, despite often leading to several side effects and the risk of an insufficient tissue penetration due to impaired blood supply. If systemically delivered, moxifloxacin penetrates well into inflammatory blister fluid, muscle, and subcutaneous adipose tissues and might therefore be a possible option for the topical treatment of skin and infected skin wounds. In this study, topical application of moxifloxacin was investigated in comparison to mupirocin, linezolid, and gentamicin using a porcine wound infection and a rat burn infection model. Both animal models were performed either by an inoculation with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. Wound fluid, tissue, and blood samples were taken, and bacterial counts as well as the moxifloxacin concentration were determined for a 14-day follow-up. A histological comparison of the rat burn wound tissues was performed. Both strains were susceptible to moxifloxacin and gentamicin, whereas mupirocin and linezolid were effective only against MRSA. All antibiotics showed efficient reduction of bacterial counts, and except with MRSA, infected burn wounds reached bacterial counts below 10(5) CFU/g tissue. Additionally, moxifloxacin was observed to promote wound healing as determined by histologic analysis, while no induction of bacterial resistance was observed during the treatment period. The use of topical antibiotics for the treatment of infected wounds confers many benefits. Moxifloxacin is therefore an ideal candidate, due to its broad antibacterial spectrum, its high efficiency, and its potential to promote wound healing.     

An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream

An open, parallel, randomized, comparative, multicenter study was implemented to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (Mepilex Ag) vs silver sulfadiazine cream (control) in the treatment of partial-thickness thermal burns. Individuals aged 5 years and older with partial-thickness thermal burns (2.5-20% BSA) were randomized into two groups and treated with the trial products for 21 days or until healed, whichever occurred first. Data were obtained and analyzed on cost (direct and indirect), healing rates, pain, comfort, ease of product use, and adverse events. A total of 101 subjects were recruited. There were no significant differences in burn area profiles within the groups. The cost of dressing-related analgesia was lower in the intervention group (P = .03) as was the cost of background analgesia (P = .07). The mean total cost of treatment was $309 vs $513 in the control (P < .001). The average cost-effectiveness per treatment regime was $381 lower in the intervention product, producing an incremental cost-effectiveness ratio of $1688 in favor of the soft silicone foam dressing. Mean healing rates were 71.7 vs 60.8% at final visit, and the number of dressing changes were 2.2 vs 12.4 in the treatment and control groups, respectively. Subjects reported significantly less pain at application (P = .02) and during wear (P = .048) of the Mepilex Ag dressing in the acute stages of wound healing. Clinicians reported the intervention dressing was significantly easier to use (P = .03) and flexible (P = .04). Both treatments were well tolerated; however, the total incidence of adverse events was higher in the control group. The silver-containing soft silicone foam dressing was as effective in the treatment of patients as the standard care (silver sulfadiazine). In addition, the group of patients treated with the soft silicone foam dressing demonstrated decreased pain and lower costs associated with treatment.     

Immunologic study of artificial skin used in the treatment of thermal injuries

Artificial skin (Integra) has been developed as an effective treatment of full-thickness burns. The material consists of a bovine collagen and chondroitin-6-sulfate dermal matrix with a silicone rubber "epidermal" layer. After burn wound excision, the artificial skin is implanted. Only the temporary silicone rubber epidermal membrane is removed. The dermal collagen matrix is incorporated by the host. Serial serum samples were obtained from patients who had grafts of Integra artificial skin for the determination of the humoral immune response to Integra. Integra artificial skin presents few if any humoral immunologic problems to patients. Increased antibody activity to bovine skin collagen, bovine skin collagen with chondroitin sulfate, and human skin collagen was not considered immunologically significant.     

Early repairing with full thickness skin graft and postoperational rehabilitation treatment of deep burn of hand

Background: To deep burn of hand,Some adopted natural healing,some adopted removal of eschar,thin and intermediate thickness skin flap repairing,But after healing,proliferation and contracture of scar of pigmentation,obvious dryness,no brightness,had elasticity often appeared that would reduce tolerance of abrade and impair function and appearnce of fingers.Objective: To investigate the clinical effect of full thickness skin graft after removal of eschar on deep burn of hand.Unit:169th Hospital of PLA.Subjects: 36 cases of deep burn of hand were investigated including 28 males,8 females,aged 2-46 years old among which were 24 cases of flame burn,6 cases of scald,3 cases of acid burn,2 cases of alkali burn with 8 cases at both hands,3 cases at both palm and dorsum of hand.Intervention:(1)After 6-8d,when edema disappeared,routine therapy was adopted to circular eschar,relief incision;One day before operation,wet packing with antibiotics and bandaging was adopted to achieve relative asepsis circummstance.(2) 0.5 before operatioin,surface of wound was brushed completely,hibitane soaking for 30 min complex iodine sterilizing operation region.(3)Eschar was removed under tourniquet.Necrosed tissue was deleted completely,avoiding injuring vessels (if longe quantity of bone substance was exposed,transferred to other method;After complet hemostasis,wet packing with saline containing antibiotics for 10 min.(4) Full thickness skinflap was reilled to keep apporiate tension.After suture subcutaneous stasis of blood was irrigated;Skin flap was pressed with bits of ganze and compression bandage.Finger and wrist were fixed with plaster support.(5) Antibiotics was used systemicly;Operation part was elevated and stitches were removed after 10d.Movement was started from 15-20d,and increased successively.Result:Wound surface of all cases healed within 25d,survival rate of skin flap was over 95%.After 0.5-1 year of follow-up,no obvious proliferation and spasm of scar and dysfunction were found,outward appearance of hand,elasticity,brightness and abrade tolerance approached normal level.Conclusion: Early full thickness skin graft could promote healing of wound surface in deep burn of hand and decrease incidence of dysfunction leaded by proliferation and spasm of scar.