皮瓣肌皮瓣修复上肢深度烧伤病人围手术期的护理

[目的]总结应用皮瓣肌皮瓣修复上肢深度烧伤的围手术期护理要点。[方法]选择2004年8月—2007年12月我科应用皮瓣肌皮瓣修复上肢深度烧伤的35例病人,进行针对性护理,包括心理护理、皮肤准备、控制感染、疼痛护理、皮瓣观察与处理、指导功能锻炼等。[结果]创面I期愈合30例,Ⅱ期愈合4例,皮瓣坏死1例。[结论]采用全面的护理方法护理皮瓣肌皮瓣修复上肢深度烧伤病人,对保证手术成功和减少并发症具有重要作用。     

腹部带蒂皮瓣修复手部深度烧伤的围手术期护理

目的探讨完整的腹部带蒂皮瓣修复手部深度烧伤围手术期护理程序。方法对48例采用腹部带蒂皮瓣手术修复手部深度烧伤的患者进行全方位的护理进行总结,包括术前疾病评估、配合清创换药、心理护理、体位和皮肤准备,感染控制,术后疼痛护理、皮瓣观察、体位护理、并发症防治、功能锻炼、康复指导等。结果48例患者腹部皮瓣移植成活,供瓣区受瓣区均生长良好。出院后3—6个月追踪,除3例术前神经血管指骨严重毁损功能丧失外,其余病例手部日常功能恢复良好。结论采用全方位多学科护理知识科学护理是腹部带蒂皮瓣修复手部深度烧伤患者的有力保障,以确保手术成功、肢体功能恢复、生活质量提高、社会生存能力增强。     

应用耳区皮瓣和颞浅筋膜神经岛状瓣的一期耳再造

目的：报告一种应用耳区皮瓣和颞浅筋膜神经岛状瓣的一期耳再造方法。方法：应用耳区皮瓣和颞浅筋膜神经岛状瓣一期再造耳41例。支架分别用自体肋软骨，硅橡胶和多孔取乙烯（MEDPOR）材料。结果：29例软骨支架和3例MEDPOR支架无任何即时并发症，3例软骨支架再造耳有所变形。2例硅橡胶支架在术后1-3个月内外露，经3个月-11年的随访，再造耳形态满意，色泽良好并能恢复部分感觉功能。结论：联合应用颞浅筋膜神经岛状瓣与耳区皮肤为耳再造提供了良好的覆盖组织。     

Pronator quadratus flap for burn reconstruction

Full-thickness skin loss in the distal volar forearm presents a challenge to the burn surgeon. Two cases are presented in which a pronator quadratus muscle flap with split-thickness skin was used to cover the underlying tendons and nerves. The unique vascular perfusion makes this a useful and predictable transfer.     

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.     

Osteocutaneous pedicle flap of the foot for salvage of below-knee amputation level after burn injury

Lower extremity amputations are occasionally required after high-voltage electric and deep thermal burns. The extensive loss of skin and soft tissue after these injuries may make it difficult to fashion below-knee amputation that will readily tolerate a prosthesis. We have found an osteocutaneous pedicle fillet flap of the foot useful in the salvage of below-knee amputation after severe burn injury. Three patients have undergone this procedure after burn injury, 1 with burn secondary to high-voltage electric injury and 2 after deep thermal burns. All became ambulatory with artificial prostheses. There were no postoperative infections and no need for further revisions. The osteocutaneous pedicle fillet flap of the foot has proven to be a reliable form of below-knee stump coverage in patients with extensive soft tissue necrosis after burn injury.     

耳后带蒂随意皮瓣贯穿法修复耳廓皮肤缺损21例效果观察

目的探讨一种修复耳廓皮肤缺损的方法。方法 21例耳廓内肿物切除术后患者采用耳后皮瓣贯穿法修复耳廓皮肤缺损。结果本组21例患者术后皮瓣存活好,无坏死,术后10天拆线。术后随访6～28个月,肿物无复发,耳廓外观及皮肤色泽良好,患者满意。结论耳后带蒂皮瓣贯穿法修复耳廓皮肤软组织缺损,操作简单易行,皮瓣易于成活,无需断蒂,手术一次完成,耳廓外形恢复良好;供皮区位于耳后,瘢痕隐蔽;耳廓修复后整体颜色相近,有较好的临床应用价值,是一种较理想的修复耳廓皮肤软组织缺损的手术方法。     

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.     

皮片移植与运动训练对足底Ⅲ度烧伤的作用

BACKGROUND: To explore the effects of skin flap graft and sports training on desree Ⅲ burn of sole of foot.     

内镜下治疗腰椎软骨板破裂症

目的探讨显微内镜下多椎板开窗治疗腰椎软骨板破裂症的有效性。方法12例腰椎软骨板破裂症患者在显微内镜下配合直式骨刀截骨减压以及L形骨刀切除椎体后缘骨性致压物,经椎板间隙切除黄韧带、部分椎板和关节突,扩大侧隐窝,切除椎体后缘骨性致压物,充分减压硬膜囊和神经根,并对临床疗效进行评定。结果除1例因硬膜囊撕裂较大改为传统手术外,完成二节段减压者2例、单节段者9例。每窗减压平均手术时间40min,每例平均出血160mL。术后2、3d下床,平均住院7d。经1.0～3.5年随访,均恢复正常工作。采用Macnab评定标准评定,优良率为90.9%。结论显微内镜下治疗腰椎软骨板破裂症,能够切除椎体后缘软骨板破裂等形成的骨性致压物,达到与开放手术同样减压的目的,并能维持腰椎稳定,术后效果优良。     

The parascapular fasciocutaneous flap for release of the axillary burn contracture

Major disturbances of shoulder function secondary to axillary burn contracture require some form of surgical release if conservative therapy has been unsuccessful. Any area large enough to need extensive skin grafts should be considered for reconstruction using a parascapular fasciocutaneous flap. This flap, which may be elevated easily, provides an option for single-stage correction of the deformity without the need for long-term rehabilitation or splinting.     

The tibialis anterior muscle flap for full-thickness tibial burns

Full-thickness burn wounds to the tibia present a challenging coverage problem. If skin grafting fails, few local options exist, and free tissue transfer may be required for coverage. We report on the use of the tibialis anterior muscle flap to cover longitudinal tibial defects in five extremities in four patients. These patients sustained 80, 55, 40, and 11% total body surface area burns. Postoperatively, all five extremity wounds healed with full coverage of the tibia. Minimal deficits in ankle inversion and eversion resulted, but all patients are fully capable of walking and able to bear weight. We feel that the tibialis anterior muscle flap is a safe, reliable, technically simple alternative for coverage of the burned tibia.     

The island myocutaneous flap reconstruction in electrical burn injuries of severely traumatized cervical region

Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and require recruitment of vascularized and massive tissues. The objective of this study was to evaluate the utility of the island myocutaneous flap for the reconstruction of the electrical burn injuries on the cervical region. We conducted a retrospective chart review on all trauma patients treated by the Department of Plastic Surgery at Changhai Hospital, Second Military Medical University who required a large amount of vascularized tissue for the reconstruction of the electrical burn injuries on the cervical region from July 1994 to June 2006. Of them, 23 patients underwent reconstruction of severe traumatic deformities and disfunction on the cervical region with 23 island myocutaneous flaps from adjacent regions. Of the 23 patients, 17 were male and 6 were female, with an average age of 38 years. Conservative surgery method for debriding necrotic tissues and three different types of island myocutaneous flaps, including pectoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapezius island myocutaneous flap were used. The defect area ranged from 6 cm x 4 cm to 20 cm x 15 cm. The sizes of the dissected myocutaneous flap ranged from 8 cm x 6 cm to 35 cm x 15 cm. All the 23 cases acquired complete recovery. The secondary defect of donor areas had primary closure after being directly sutured or covered with skin grafts. Island myocutaneous flaps have distinctive advantages in treatment of electrical burn injuries on cervical region and it can obtain satisfactory functional and cosmetic outcomes.     

Steam press hand burns: A serious burn injury

Steam presses cause full-thickness burns when the operator's extremity is caught between the buck and the head of the steam press. Patients with serious steam press burns should be referred to a regional burn center for excision of the full-thickness burn and coverage by either a split-thickness skin graft or a flap. The safety features in steam presses that could prevent this serious injury include: (1) emergency safety releases, (2) peripheral safety bars, and (3) two-hand operator control.     

腹部带蒂皮瓣修复手腕部烧伤患者的护理

笔者报道97例手腕部烧伤患者采用腹部带蒂皮瓣移植修复术的护理。强调术前心理护理和体位锻炼，术后着重观察皮瓣血运和冲洗管护理，协助进行恢复性训练。患者均取得良好的治疗效果。     

应用预构皮瓣治疗颜面部大面积烧伤后瘢痕患者的护理体会

目的探讨应用预构皮瓣治疗颜面部大面积烧伤后瘢痕患者的护理方法。方法便利抽样法选取2015年10月至2016年2月在上海交通大学附属第九人民医院整复外科行预构皮瓣技术治疗颜面部大面积烧伤后瘢痕患者9例,做好扩张器植入期、注水期以及预构皮瓣转移术的术前、术后护理。结果 8例颜面部大面积烧伤后瘢痕患者应用预构皮瓣治疗成功,成功率达到88.9%;1例患者部分皮瓣坏死,经重新修复治疗后痊愈。结论系统、规范地观察及护理可预防和减少预构皮瓣治疗颜面部大面积烧伤后瘢痕患者并发症的发生,避免患者再次手术的痛苦;及时的心理护理可以缓解患者负面心理情绪,增强患者治疗的信心。     

应用脐旁皮瓣修复会阴部烧伤瘢痕挛缩畸形临床效果观察

目的探讨应用脐旁皮瓣修复会阴部烧伤瘢痕畸形的临床效果。方法 2003年3月至2011年1月我院整形外科收治会阴部烧伤瘢痕畸形患者32例。术中完全松解及切除会阴部瘢痕组织,使尿道口、阴道口及肛门恢复到解剖位置。肛门严重狭窄者,需彻底切除肛门周围及肛管的瘢痕组织,完全解除狭窄,使肛门口充分开放,将形成的脐旁皮瓣行明道转移至会阴部。在皮瓣中间对应尿道外口及肛门位置切开形成尿道及肛门外口,肛门外口与直肠黏膜缝合,将皮瓣缝合于会阴创面。结果 32例患者中3例出现皮瓣远端发绀,经检查发现2例皮瓣下积血,1例因缝合张力过大引起。清除血肿及拆除部分缝线后皮瓣远端循环得到改善,皮瓣完全存活,经延迟拆除缝线后伤口愈合。1例出现皮瓣感染,导致远端部分坏死,后通过植皮进行创面修复。术后随访0.5～1年,术后皮肤质地、会阴外形功能及生殖器位置均良好;双髋活动度除2例因缺乏功能锻炼及皮瓣皮片后期挛缩恢复不理想外,其余双髋活动度良好。结论脐旁皮瓣不受会阴瘢痕限制,组织相似度好,血管恒定,抗感染能力强,是修复会阴部瘢痕畸形的理想皮瓣。     

深度手烧伤的治疗及功能康复

目的 :探讨深度手烧伤早期创面修复及功能康复最好的治疗方法。方法 :应用中厚皮、异体去细胞真皮基质作支架加自体刃厚皮片移植 ,腹部真皮血管网皮片及超薄皮瓣移植等手术方式 ,进行深度手烧伤早期切削痂。结果 :2 94例 4 6 2只手功能良好者 138例 2 32只手 (5 0 % ) ,功能较好者 79例 134只手 (2 9% ) ,功能障碍者 77例 96只手 (2 1% )。结论 :应用早期切削痂植皮的方法可减少瘢痕增生和畸形 ,使深度手烧伤后获得满意的外形和功能     

15例皮肤软组织扩张器整复会阴部烧伤瘢痕患者的观察和护理

总结了15例皮肤软组织扩张器整复会阴部烧伤瘢痕术相应的护理对策.术前做好充分准备,做好会阴部瘢痕处的污垢清除,指导饮食,服用肠道抑菌、收敛、止泻药物,防止污染创面,女性患者择期安排手术.术后密切观察皮瓣的血液循环情况和并发症的早期征象,保持术区皮瓣清洁,确保扩张皮瓣成功,并注重每个环节的细节护理.     

Chemical burn caused by dermal injection of potassium chloride

This report contains images and a summary of a 31-year-old male patient who presented with skin lesions after subcutaneous injection of potassium chloride in an attempted suicide. Both forearms showed formation of vesicles with purple necrotic changes. Escharotomy, debridement, artificial skin graft, and local flap surgery were performed during hospitalization. This report includes images illustrating the course of the chemical burn due to subcutaneous injection of potassium chloride, and a brief review.