手部套脱伤的分型与程序化治疗临床应用研究

目的 探讨手部皮肤套脱伤的分型与治疗方式.方法 依据不同的伤情与手术治疗方法,将手部套脱伤分为六种类型.针对不同分型,提出程序化治疗的概念,采取点对点的应对措施,并使用了阶梯式修复血管、交替式切口清创、局限性缝合固定、区域性加压包扎及散在性切口引流等技术.结果 本组共144例,获得10年以上随访49例,5年42例,3年24例,1年20例,5个月9例.15例全手套脱伤中仅1例手背部分皮肤作了游离植皮治疗,小指部分坏死作了截指;其他类型的皮肤撕脱和手指套脱伤经治疗全部存活.皮肤外形美观,耐磨擦能力强,基本恢复了原来的手功能.结论 手部套脱伤六型分类法切合临床实际,程序化治疗采用点对点的应对措施,便于临床迅速展开救治.其中的关键技术解决了手部套脱伤手术中的技术难题,术中、术后相关辅助措施进一步提高了手部皮肤套脱伤治疗的成活率.程序化治疗为临床手部套脱伤的救治开辟了一条全新的途径.

Classification and sequential management of hand avulsion injuries

objective To introduce classification of avulsion injuries of the hand and the treatment methods. Methods Based on conditions of the injury and various surgical treatment options, avulsion injuries of hand were classified into six types. Corresponding to different injury types, we proposed the concept of sequential management. Type specific measures were taken including segmental blood vessel repair, alternating debridement, limited closure and fixation, localized pressing dressing and sporadic draining. Results A total of 144 eases were treated. Follow-up period was over 10 years in 49 cases. 5 years in 42 cases, 3 years in 24 cases, 1 year in 20 cases and 9 months in 5 cases. Among 15 cases of total avulsion of the hand, only one had partial necrosis at the dorsum of the hand that required secondary skin graft and partial necrosis of the little finger that led to amputation. In the rest cases the avulsed hand or fingers all survived. The appearance of the skin was satisfactory and hand function as good. Conclusion The 6 type classification of hand avulsion injuries is practical in clinical situation. Sequential management based on the classification facilitates timely salvage of the soft tissues. The key techniques solved the difficult problems in surgical treatment of hand avulsion injuries. The relevant assisting measures increased survival area of avulsed skin. Therefore. this strategy opens a new venue for treatment of the avulsion injury of the hand.