改良负压封闭引流治疗手部高压注射伤

目的：总结应用改良负压封闭引流技术治疗手部高压注射伤的临床疗效。方法2009年6月-2012年10月,对6例手部高压注射伤急诊彻底清创后采用改良负压封闭引流治疗,负压冲洗引流7～14 d（平均9.3 d）。结果6例创面均无感染、无毒素吸收而引起全身反应;冲洗引流1～2周后拆除负压引流装置,行创面直接缝合或游离植皮;创面愈合均良好,手部功能恢复理想。结论对手部高压注射伤一期行扩创清除异物,并应用改良负压封闭引流技术治疗,可有效预防感染,缩短治疗时间,减少伤残率。     

游离皮瓣修复手、前臂感染创面的几点体会

本文小结了我科8年来,应用游离皮瓣修复手、前臂感染创面19例。主要是电击伤、热压伤、撞伤所致。手深部组织损伤、外露及坏死的创面。分别对创面进行术前、术中消毒,扩创后,术后引流四个阶段的细菌培养、分析提示感染的创面、认真扩创、彻底去除     

下腹宽蒂皮瓣修复前臂及手深度热压伤

目的：观察下腹宽蒂皮瓣修复前臂及手深度热压伤创面的临床效果。方法：4例前臂及手背侧深度热压伤患者,创面面积15cm×8cm～18cm×12cm,采用下腹宽蒂皮瓣修复创面。结果：4例皮瓣全部成活,创面愈合满意,手功能恢复满意。结论：下腹宽蒂皮瓣能有效修复前臂及手背侧深度热压伤创面。     

手部高压注射伤精细微创治疗

目的探讨手部高压注射伤的精细微创手术治疗的效果。方法对12例手部高压注射伤患者在显微镜下精细一期清创、减压、冲洗引流,二期行游离植皮或皮瓣修复。结果患者均获得随访,时间6~12个月。手部活动度根据TAM功能评定法评价:优3例,良7例,中2例。结论手部高压注射伤是一种严重的复合性损伤,早期切开减压、精细清创、有效引流、延期闭合创口是有效的治疗方法。     

手部油漆高压注射伤的治疗

目的：探讨手部高压注射伤急诊清创及二期修复闭合创面的方法。方法对6例手部油漆高压注射伤患者,急诊于显微镜下行彻底清创手术,若不能一期清除干净,则将伤口敞开,二次清创闭合创口。结果本组4例一期愈合,2例经二期手术扩创后愈合。术后功能恢复优5例,良1例,6例患者均重返工作岗位。结论对于手部油漆高压注射伤的治疗,早期清创,开放伤口,必要时重复清创及二期闭合创面,可以获得较好的治疗效果。     

手部高压注射伤伴发感染的治疗

目的探讨应用VSD引流技术及皮瓣移植术治疗手部高压注射伤伴发感染的效果及应用价值。方法2017年12月-2018年12月应用VSD引流结合皮瓣移植治疗伴发感染的手部高压注射伤5例,行扩大清创术后,予VSD引流治疗1~2周,更换VSD敷料2~3次,引流期间每日行2~3次手功能康复训练,去除VSD后残余创面行皮瓣修复。术后对伤口愈合情况及手功能进行随访。结果所有感染创面经VSD治疗后,炎症反应均控制良好,为皮瓣覆盖创造条件;皮瓣修复术后随访6~12个月,皮瓣外形良好,手功能恢复满意。结论对伴发感染的手部高压注射伤,经扩大清创术后,应用VSD引流结合皮瓣修复,可明显缩短治疗周期,减少继发性组织损伤,更好地恢复肢体功能。     

游离股前外侧穿支皮瓣修复手及前臂大面积热压伤创面

目的探讨游离股前外侧穿支皮瓣修复手及前臂大面积热压伤创面的方法及临床疗效。方法 2016年1月-2019年12月,对8例手和前臂热压伤患者急诊行前臂清创,切开焦痂减压,VSD治疗;待创面清洁后,择期行骨折复位内固定术,修复断裂肌腱后,行游离股前外侧穿支皮瓣修复创面。术后定期复查,指导功能康复训练,观察皮瓣的外观、质地、感觉,前臂和手功能及供区的恢复情况。结果术后8例皮瓣及植皮全部成活,1例皮瓣覆盖创面因前臂肌腱坏死、创缘渗出,经换药后愈合。8例均获得随访,随访时间为3～18个月。皮瓣外形美观,不臃肿,质地良好,与受区相似,两点辨别觉12～20 mm;手功能恢复良好,基本恢复正常的生活。结论手和前臂热压伤损伤组织层次深浅不一,常累及多种组织,修复难度大;股前外侧皮瓣解剖恒定,皮肤质地良好,可同时修复不同组织,是修复手及前臂热压伤的一种理想方法。     

手部高压注射伤的治疗

目的 报告6例手部高压注射伤的治疗方法与效果。方法 所有伤指(手)均经2或3次清创，清创后的创面均采用手背逆行筋膜蒂皮瓣修复。结果 1998年10月至2001年10月，用该法治疗手部高压注射伤6例，皮瓣全部存活，伤指运动功能良好。结论 2～3次的清创和早期用皮瓣覆盖创面是保存伤指良好运动功能的关键。     

手部高压注射伤的治疗特点

[目的]探讨手部高压注射伤（high-pressure injection injuries of the hand，HPIIH）的发病机制，分析切开引流对其病程发展的影响。[方法]2001年11月～2005年11月，对5例手部高压注射伤作了切开引流、清创。[结果]3例伤口愈合良好，1例指腹和甲床部分坏死，作了邻指皮瓣修复，1例手指末节坏死于远侧指间关节以远截指。[结论]手部高压注射伤因注入物不同，造成结果差异较大。首次切开引流的时间常决定病程发展与疗效。切开引流充分是治疗的及时措施，必要时需多次清创引流。     

手部高压注射伤的特点及治疗

目的：探讨手部高压注射伤的特点、治疗方法和疗效。方法对2010年1月—2013年12月收治的30例手部油漆等高压注射伤,一期采用清创、局部持续冲洗或封闭负压引流（vacuum sealing drainage, VSD）等措施,二期行植皮或皮瓣手术治疗。结果各指创面愈合良好,未发生手指坏死,术后随访3～36个月,手指屈伸功能基本恢复,治疗效果满意。结论把握高压注射伤的特点,采取早期、及时、合理的治疗方法、配合适当的手功能康复锻炼是治疗的关键。     

手部化学液体高压注射伤11例的治疗

目的 探讨手部化学液体高压注射伤的临床治疗.方法 对11例手部化学液体高压注射伤患者,采用一期清创、减压、冲洗引流,二期行游离植皮或腹部皮瓣修复.结果 所有患者均获术后随访,时间4～13个月,平均8.5个月,根据TAM功能评定法评价：优7例,良3例,差1例.结论 手部化学液体高压注射伤是一种严重的复合性损伤,临床易失治误治,致残率很高.这种损伤后期基本都会出现组织坏死,早期切开减压、彻底清创、开放引流、延期闭合创口是目前治疗手部化学高压注射伤最主要、有效的方法.     

Experience with the island radial forearm flap in local hand coverage

Use of the island radial forearm flap (RFF) for soft-tissue coverage of hand and forearm following mutilating injuries, chemotherapeutic injection sloughs, and tumor excisions are discussed. Twenty-eight flaps were used in 28 injured upper extremities. Partial flap loss occurred in three patients. Minor sloughing of the skin graft of the donor site occurred in four. Twelve patients had persistent dysesthesias and paresthesias in the injured extremity. All patients complained of some degree of weakness in the injured extremity. Our experience supports the use of this flap for local hand and forearm coverage when local tissue is unavailable and skin grafting is deemed inadvisable. Donor site problems have been acceptable in our patient population.     

Concurrent musculoskeletal complaints in elbows,shoulders, and necks after common hand and forearm injuries or conditions: A cross-sectional study among 600 patients

Study designThis is a cross-sectional study among 600 patients.IntroductionIsolated hand and forearm injuries or conditions are common in the emergency and orthopedic departments. So far, little is known about whether these patients suffer from concurrent musculoskeletal complaints (MSCs) besides their hand and forearm complaints. Neglecting concurrent MSCs in the upper limbs and necks could hamper rehabilitation and prolong the time taken to return to daily and work-related activities.Purpose of the studyThe purpose of this study was to investigate the prevalence of concurrent MSCs in the elbow, shoulder, and neck after common hand and/or forearm injuries or conditions.MethodsThis study included 600 patients with any type of diagnosis referred to rehabilitation after hand and/or forearm injuries or conditions. Basic characteristics, diagnoses, and location of patients' symptoms were collected and analyzed.ResultsThe overall prevalence of concurrent MSCs was 40%. Twenty-eight percent of the whole sample developed concurrent MSCs after the hand and forearm injury or condition. The gender distribution was 68% women and 32% men. The most common location for complaints was the shoulder (62%), followed by the elbow (49%), and the neck (32%).DiscussionThe present results suggest that MSCs from the elbows, shoulders, or necks are very common in patients with hand and/or forearm injuries or conditions.ConclusionClinicians treating patients with isolated hand and forearm injuries or conditions should be aware of the high prevalence of concurrent MSCs. Future research should investigate if specific rehabilitation, focusing on concurrent MSCs, may influence the outcome in this population.     

High pressure injection injuries of the hand with surfacer

The most commonly injected materials in high-pressure injection injury to the hand include paint, automotive grease, solvents and diesel oil. High-pressure injection injuries are a frequently mismanaged problem, as they are often not recognized and treated early, which may result in a compromised function of the hand or even the amputation of a digit. Early diagnosis is an important factor, as well as the type and amount of injected material and the injection pressure at appliance. We present one case of high-pressure injection injury to the hand with the surfacer Caparol Accord. This report describes the principles of treatment and gives an overview of the literature about tissue injuries caused by components of different substances encountered in high-pressure injection injuries.     

自制高压助推器在注射治疗瘢痕疙瘩中的应用研究

目的：结合癜痕内注射治疗癜痕疙瘩难以完成的临床情况，开发研制出有利于药物完全、均匀注入癜痕内确保疗效的高压注射助推器。方法：采用专利产品高压助推器与一次性注射器相结合，于癜痕内注射“得宝松“进行治疗癜痕疙瘩并有效的防止其复发。结果：189例入选皮损大小病例经注射治疗有效率达100%，同时注射过程中药液分布均匀，无药液外溢。结论：癜痕内注射治疗，疗效肯定，在借助高压注射助推器后，使操作更加简单、省力，并保证了注射的准确和完全性，提高了疗效。     

Subclinical injuries in lacerations to the forearm and hand.

This report describes the incidence and severity of subclinical injuries to underlying structures in lacerations to the hand and forearm. One hundred consecutive hand and forearm lacerations that penetrated the full thickness of subcutaneous tissue were studied prospectively. Lacerations were explored under either biceps or forearm tourniquets. Injuries, treatment, tourniquet time, causative agent and complications were recorded. In all, 97 patients sustained 100 lacerations. A total of 49 deep injuries were discovered, none of which was detected clinically before exploration. Of these, 33 were tendon lacerations; 21 tendons, including three flexor tendons, were repaired. Nineteen patients required treatment in a volar slab for at least 3 weeks. Five patients of 49 returning for review developed wound infection. No patient developed significant problems related to the tourniquet, which was inflated for a mean time of 4.9 min. There is a high incidence of subclinical injury in full-thickness lacerations of the forearm and hand. These should be explored under tourniquet, which should minimize complications such as wound infection and delayed tendon rupture.     

High-pressure injection injuries of the hand.

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.     

前臂缺血性肌挛缩早期手术治疗

目的探讨前臂缺血性肌挛缩早、晚期手术疗效,提出早期行肌肉神经松解减压术的重要性。方法回顾性随访、分析1988年1月~1997年12月收治的42例前臂缺血性肌挛缩早、晚期手术远期效果、观察手内在肌挛缩程度、手部感觉功能恢复与手术距受伤时间之间的关系。结果获随访26例,随访时间半年~10年。早期(6个月内)手术19例,优良率84.2%。晚期(6个月以上)手术7例,优良率28.6%。结论肌肉神经松解减压术宜早期施行。手术时间在损伤后3个月内最佳。晚期手术效果差的主要原因是神经长时间卡压致手内在肌挛缩、感觉丧失。     

Hochdruckeinspritzverletzungen an der Hand

The severity of high pressure injection injuries to the hand is often underestimated in the initial clinical examination. Therefore, it is critical to obtain information about the course of the accident, the pressure involved and the injected substance. X-ray examination can reveal the injected substance or accompanying air in the tissues and therapy is usually surgical. All compartments should be released and all foreign material should be thoroughly removed. There is often a need for second look surgery. Wound closure should be achieved within 1 week and the decision about amputation should fall within 2 weeks. Hand therapy is essential beginning from the day after trauma and it may be continued for weeks or even months. From 1998 to 2008, 36 patients were treated after high pressure injection injury to the hand, 19 patients were transferred to the replantation centre immediately and 17 secondarily. These 19 injuries resulted in finger amputations and/or pain syndromes in 12 patients (33%) including 2 out of the primary group (10%) and 10 out of the secondary group (59%). It can be concluded that high pressure injuries to the hand should be treated in replantation centres.