手部Ⅲ度烧伤后期硬性水肿11例

Hard edema following third degree burned hands

作者报道手部Ⅲ度烧伤切痂植皮愈合后期出现硬性水肿11例17只手.其中9例14只手的指背区烧伤,毁及伸肌腱、指骨和指间关节,伴软组织感染,炎症反应持续存在,手指肿胀,扩散至手背;富含蛋白质的水肿液纤维化,形成硬性水肿、另2例3只手烧伤,手及前臂早期切痴网状植皮,愈合后亦出现硬性水肿,此与前臂环状植皮区挛缩,淋巴回流受阻有关.作者认为,对硬性水肿应加速封闭残存创面,坚持手部康复锻炼.17只手中,随诊时功能恢复良好者10只手,其余需继续康复和整形治疗.

Author report 11 burned cases with 17 hands of hard edema in the late stage of wound healing of escharectomy and skin grafting. Of them, 9 cases with 14 hands consisted severe bum involving extensors , phalangeal bones and joints with soft tissue continuing inflammation spreading into the dorsum of hand . The plentiful protein of inflamatory fluid was fibrous and became hard edema sequentially . The other 2 cases with 3 hands had been treated with escharectomy and mesh grafting on the dorsum of hand and circumferential forearm . Hand edema occurred too. This may be related the contraction of circumferential mesh grafting to impairment of lymphatic return . Accelerated covenng deep burn wounds and continual rehabilitation management can be help to hard edema . In this series 6 cases with 10 hands got good result following up . The other cases should continue to do rehabilitation and plastic repair .