手烧伤后瘢痕畸形的防治

手烧伤后瘢痕畸形的防治潘圣鑫广西玉林地区人民医院烧伤整形科（５３７０００）手烧伤在临床非常多见，因为烧伤后引起的手部瘢痕挛缩畸形也很多。因手是人的重要功能部位，手功能障碍对人的劳动能力，及生活自理能力均带来严重影响。因此，如何使手烧伤后的治疗能尽可能...     

中西医结合治疗手深度烧伤后瘢痕畸形

对38例手部烧伤后瘢痕及瘢痕挛缩畸形进行整形外科手术及术后综合康复治疗,取得满意的效果。     

小儿手部烧伤瘢痕挛缩畸形8例

小儿手部烧伤治愈后瘢痕增生、挛缩,由于患者得不到及时治疗,发展成关节挛缩,累及韧带、关节、肌腱,以往手术分期进行,本组8例手术进行了新尝试。1　资料与方法11　一般资料　本组共8例,13只手,男6例,女2例,最小5岁,最大8岁,受伤时间最短2年,最长5年,平均两年半,均为烧伤烫伤。瘢痕位于手背5只,手掌8只,均为关节挛缩型。12　手术方法　均采用静脉复合麻醉。术前上止血带,植皮前松一次止血带。手术作“Ｚ”形切口,充分暴露关节面。切除部分瘢痕组织,充分暴露关节面及两侧韧带,切开关节囊,切口小于1/2周,切断双侧韧带,持续牵引远端,将关节复位…     

73例烧伤瘢痕挛缩畸形的治疗

作者1988年3月至2005年9月共收治眼周、颈部、手背、会阴等部位遭受深度烧伤所致瘢痕挛缩畸形整复73例，现对其临床资料，着重治疗原则和方法加以分析讨论。报告如下。     

烧伤后会阴部瘢痕挛缩畸形的整形治疗

目的探讨烧伤后会阴部瘢痕的修复与康复方法。方法解放军白求恩国际和平医院烧伤整形科1989-10／2004-10住院治疗的烧伤患60例。术前强调肠道清洁和局部瘢痕清洗；术中根据瘢痕挛缩畸形的具体情况，采用“Z”成形术或五瓣成形术加厚中厚皮片移植24例；局部皮瓣及大张厚中厚皮片移植18例，全厚皮片移植10例，单纯用局部皮瓣移植8例。术后注意保持创面的清洁干燥和进行及时有效的功能锻炼。结果60例患均进入结果分析。①皮瓣及植皮均成活良好，局部畸形完全纠正，阴茎、阴囊、大阴唇恢复到正常位置，患对治疗后效果满意。②治疗后两侧髋关节活动正常，皮肤质地柔软占87％(52／60)。外生殖器恢复正常位置，局部畸形基本纠正，两侧髋关节活动良好占10％(6／60)。局部仍有瘢痕牵拉，经Ⅱ期手术修复后外生殖器基本恢复正常位置，两侧髋关节活动良好占33％(2／60)。结论根据会阴部瘢痕挛缩畸形的特殊性，合理设计、选择手术方法，结合术后功能锻炼，能够获得满意的治疗效果。     

烧伤后期颈部瘢痕挛缩畸形的康复治疗

目的：通过对34例颈部瘢痕挛缩畸形整复方法的临床总结,找出修复颈部瘢痕挛缩畸形的最佳方法。方法：采用Z成形术、植皮术及皮瓣转移术配舍功能锻炼修复颈部瘢痕挛缩。结果：34例患均获满意疗效。结论：手术及术后抗挛缩治疗为修复颈部瘢痕挛缩畸形的关键。     

烧伤后面部瘢痕挛缩畸形的治疗探讨

面部是最具特征性的暴露部位,面部的眼、耳、鼻及口等器官和谐地构成人体的容貌,管理着视、听、嗅、呼吸、饮食、说话以及表情等重要功能,遭受烧伤损害,轻者留下瘢痕,重者造成毁容,严重影响患者的面部形态及功能,并给患者带来巨大的精神和心理影响[1-2],整形外科医师应最大限度地修复重建患者的面部容貌和功能。一、治疗原则     

烧伤后期颈部瘢痕挛缩畸形的康复治疗

目的：通过对３４例颈部瘢痕挛缩畸形整复方法的临床总结,找出修复颈部瘢痕挛缩畸形的最佳方法。方法：采用Ｚ成形术、植皮术及皮瓣转移术配合功能锻炼修复颈部瘢痕挛缩。结果：３４例患者均获满意疗效。结论：手术及术后抗挛缩治疗为修复颈部瘢痕挛缩畸形的关键。     

烧伤后会阴部瘢痕挛缩畸形的整形治疗

目的探讨烧伤后会阴部瘢痕的修复与康复方法。方法解放军白求恩国际和平医院烧伤整形科1989-10/2004-10住院治疗的烧伤患者60例。术前强调肠道清洁和局部瘢痕清洗;术中根据瘢痕挛缩畸形的具体情况,采用“Z”成形术或五瓣成形术加厚中厚皮片移植24例;局部皮瓣及大张厚中厚皮片移植18例,全厚皮片移植10例,单纯用局部皮瓣移植8例。术后注意保持创面的清洁干燥和进行及时有效的功能锻炼。结果60例患者均进入结果分析。①皮瓣及植皮均成活良好,局部畸形完全纠正,阴茎、阴囊、大阴唇恢复到正常位置,患者对治疗后效果满意。②治疗后两侧髋关节活动正常,皮肤质地柔软占87%(52/60)。外生殖器恢复正常位置,局部畸形基本纠正,两侧髋关节活动良好占10%(6/60)。局部仍有瘢痕牵拉,经Ⅱ期手术修复后外生殖器基本恢复正常位置,两侧髋关节活动良好占33%(2/60)。结论根据会阴部瘢痕挛缩畸形的特殊性,合理设计、选择手术方法,结合术后功能锻炼,能够获得满意的治疗效果。     

Plastic surgery treatment on cicatricial deformation in child burn of hand

Background:cicatricial deformation in child burn of hand often leads to severe squaelae.According to different causes of disease,different plastic surgery were adopted.The key of operation lies in skin repairing,articulation dealing,and thumb correcting,which aim is to resume normal longitudinal and transverse arce,holding and clenching ability.Objective:To investigate plastic surgery treatment on cicatricial deformation in child burn of hand.Unit:first People‘s Hospital of Yancheng City.Subjects:34 cases of burn were investigated including 23 males,11 females,aged 5-12 years old.Cicatricial reason:deep degree Ⅱ burn,19 cases;degree Ⅲ burn 11 cases;electric injury,4 cases.Scar type:hypertrophic scar,21 cases,areophic scar,13 cases.portion:dorsum of hand,22 cases,palm,12 cases.Time from healing to dealing:within 6 months,9 cases,within 1 year,8 cases,1-2 years,13 cases,over 3 years,4 cases.Intervention:Before operation,hypertrophic scar and adhesive web-space were cleaned with soap solution,1:5000 bromogeramine,30 min per time,twice a day.Anesthesia:general anesthesia to simple cicatricial contracture,scar removing,relaxing and free graft were adopted,full split thickness graft of palm,intermediate split thickness graft of dorsum of hand.To severe contracture,besides complete removing and full and intermediate split thickness graft,repairing of extensor tendon and articulate surgery,proximal finger joint was fixed at functional position when function couldn‘t be resumed.Tourniquet was used routinely,great saphenous venous and dorsal cutancous branch of radioulnar nerve avoiding exposing extensor tendon,fixed with plaster support and kirschner pins for some cases.Direct skin flap was used after incision and relaxing in 19 cases,skin flap graft was combined with repair in 15 cases.To scar contracture of part between thumb and index finger,because soft tissue had a good condition in this part,“Z”plastic operation was adopted for linar scar,local transfering of dorsal skin flap i 5 cases.To slight false web-space and adhesion,“Z”plastic operation was adopted,“M”or “T” skin flap repair to severe deformation and reconstructing of web-space with free skin graft when necessary.Result:Following up for 3-6 months,hand function recovered completely,improved obviously in 12 cases,no obvious effect was found in cases of deep burn.Conclusion:Different plastic surgery has an obvious effect on child hand bur,but the recovery of function needed long and effective rehabilitation therapy.     

手背深度烧伤早期治疗与功能康复

Background: The main reasons of deep hand burns were heat and chemical agents; deformity and functional disorder were often left if improperly dealt with. Deep burn usually happen on the hand back for its thinner skin. There will be enough skin supply region if the burn surface of hand back was not very big, so the skin should cut early if the patients' conditions were suitable. Objective: To discuss the treating effects of early rehabilitation treatment on hand back deep burn. Unit: The Central Hospital of Baoji City.     

Early treatment and functional rehabilitation of hand back burn

Background：Themainreasonsofdeephandburnswereheatandchemicalagents;deformityandfunctionaldisorderwereoftenleftifimproperlydealtwith．Deepburnusuallyhappenonthehandbackforitsthinnerskin．Therewillbeenoughskinsupplyregioniftheburnsurfaceofhandbackwasnotverybig,sotheskinshouldcutearlyifthepatients＇conditionsweresuitable．Objective：Todiscussthetreatingeffectsofearlyrehabilitationtreatmentonhandbackdeepburn．Unit：TheCentralHospitalofBaojiCity．Subject：Therewere４９casesinthegroup（７４han…     

手部深度烧伤后畸形防治体会

INTRODUCTION How to prevent hand deformity caused by burn, restore appearanceand working ability has been alwaya the main problem, the follow-ing is the report about causes of deformity and experience of pre-vention and treatment.     

护理干预对深度手烧伤患者治疗依从性及术后功能恢复的影响

目的 探讨护理干预对深度手烧伤患者治疗依从性和术后功能恢复的影响.方法 将深度手烧伤患者90例按随机数字表法随机分为干预组和对照组各45例.对照组患者术后给予常规护理;干预组给予系统护理干预,比较两组患者对治疗的依从性和术后功能恢复情况.结果 干预组患者对治疗的依从率为97.78％,对照组患者对治疗的依从率为80.0％,组间比较差异有统计学意义(X2=4.316,P＜0.05);术后1个月,两组间手部外观及感觉的恢复,差异无统计学意义(P＞0.05);应用上肢功能评价表(DASH)评价术后功能的恢复,出院后6个月干预组术后感觉和外观恢复评分为(45±3)分,出院功能恢复评分为(25±5)分,对照组分别为(33±4)分和(43±5)分,两组组间比较差异有统计学意义(t分别为1.249,10.599;P ＜0.05).结论 护理干预可以提高深度手烧伤患者对医护人员的治疗依从性,并且对患者术后早期及出院后的功能恢复有明显的促进作用.     

全厚植皮早期修复及早期术后康复治疗手深度烧伤

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 or pigmentation, obvious dryness,no brightness, bad elasticity often appeared that would reduce tolerance of abrade and impair function and appearnce of fingers.     

系统护理干预对深度手烧伤病人治疗依从性和术后功能恢复的影响

[目的]探讨护理干预对深度手烧伤病人治疗依从性和术后功能恢复的影响。[方法]将80例深度手烧伤病人随机分为对照组和干预组,两组病人手术后分别给予常规护理和系统护理干预,比较两组病人对治疗的依从性和术后功能恢复情况。[结果]干预组病人治疗依从性明显高于对照组(P<0.05),两组手部外观及感觉的恢复差异无统计学意义(P>0.05),功能恢复组间差异有统计学意义(P<0.05)。[结论]系统护理干预的实施可以提高深度手烧伤病人对治疗的依从性,对病人术后早期及出院后的功能恢复有明显的促进作用。     

深度手烧伤患者植皮术后功能康复护理

通过对100例手深度烧伤(深Ⅱ-Ⅲ度)削切痂、植皮术病人术后2周实施加压疗法、浸浴疗法、局部按摩、药物治疗、功能锻炼及心理护理、创面护理，结果 100例131只手获得较满意效果。提出护理时尽量减少康复活动引起的疼痛，训练强度循序渐进，以病人耐受为度。     

手部深度烧伤后保留功能预防瘢痕增生的早期治疗

Background: Deep burn of hands can cause severe dysfunction. Early plerosis to the hands will play an important role to the functional exercise and the recovery.