| 摘 要： | 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.Objective:To observe the effect of early treatment of deep burn of hands to the functional reservation and prevention of scar proliferation.Unit:Department of Burn,People‘s Hospital of Gansu Province.Subjects: 1118 burned patients were recruited during December of 1998 to December of 2001.In them 252 patients were complicated with burn of hands,in which 129 hands were deep burns (96 males and 33 females,aged from 1 to 67,most of them were yound).The causes of burns were flame burn,scald by hot fluid,electric burn,chemical burn and hot crush injuries.Intervention:Excise the eschar of 59 hands with burns of deep Ⅱ to superficial Ⅲ and 21 hands with burn of Ⅲ degree.Perform dermatoplasty of local skin flap,abdominal flap,dorsolateral flap of index finger,reticular thin flaps with pedical containing subdermal vessels and fascial flaps to the 15 hands with injuries of tendons,bones and joints;Cut off granular wound surface and transplant large piece of intermediate split thickness skin graft and full split thickness skin graft to 5 hands;transplant postage stamp-shaped razor-thin graft or intermediate split thickness skin graft to 14 hands.Results:In the 129 hands,103 hands could keep the functios in maximal degrees 1-2 weeks after burning,most of them could begin to move after taking out stitches and could care themselves in the end.After 4-5 weeks,the hands with deep Ⅱ burn could recovery functions after dressing change,new skin excision,transplantation of large piece of intermediate of full split thickness skin graft,All of Hands Could resume the functions.In 14 patients with transplantation of stamp-shaped skin flaps on granular wound surfaces of hands‘ bank and fingers,the contracture were prominent and claw hands were formed in the late phase.11 hands of mixed burns of deep Ⅱ and Ⅲ were self-healed after repeated dressing change,proliferative scars appeared 4-5 weeks after burn.Although local medication and active and passive training,the hands were still with dysfunctions and take operative plerosis in late phase.Conclusion:Deep burn of hands should be treated with corresponding methods 1-2 weeks after the burning,which could reserve the functions,decrease mutilation rate and prevent contracture of scars in greatest degrees.
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