烧伤后手指和指蹼挛缩畸形的治疗及功能康复

The treatment and functional rehabilitation of burned scar contracture of fingers and digital web-spaces

目的:探讨烧伤后手指和指蹼挛缩畸形的手术治疗和功能康复方法。方法:本组33例45只伤手,采用瘢痕切除或切开加皮片移植术修复127个手指挛缩畸形,采用局部皮瓣或皮片移植术分别修复36只和60只指蹼畸形。手术后早期进行关节功能训练、按摩、弹力手套压迫等康复治疗。结果:皮片移植和皮瓣全部成活,手指间关节和掌指关节功能、指蹼功能均有改善,皮瓣法修复指蹼优于皮片法。通过功能康复治疗,87.9%患者生活能够完全或大部分自理。结论:对烧伤后手指瘢痕挛缩畸形采用手术和功能康复治疗可取得较好的效果,手指侧方皮瓣修复指蹼畸形,手术简单可靠,效果好。

Objective：To explore the methods of treatment and functional rehabilitation of scar contracture in burned hand.Method：33 patients（45 hands） were treated in our department from Jan 2001 to Apr 2005. All the hands had severe scar contracture on the dorsum or/and palm. Surgical releases and skin autografts were performed to repair scar contracture burned hand. Dorsolateral flap from the finger was designed to release flexion contracture. Early post-operation functional rehabilitation, including joint exercises and elastic pressure garments were used to improve hand function.Result：All skin grafts and skin flaps survived after the operation. All patients were followed-up 3 months to 2 years postoperatively. The range of motion of metacarpophalangeal joint and interphalangeal joint and space capacity of the digital web-space were greatly improved. Reconstructed digital web-spaces were excellent in 18/36 on the surgical flap group, compared with 15/60 on the free skin graft group. Most cases 87.9% regained self-care ability and satisfaction with hand function.Conclusion：This is an easy and safe method for scar contracture in burned hand. The function of the burned hand could be greatly improved by this method.