严重烧伤行手急诊切痂功能性治疗

The functional therapy of emergency hand scab-removing in serious burns

目的 :提高手部深度烧伤治疗质量。方法 :将重度以上合并手深度烧伤 85例分为传统治疗组 (A组 )和改良治疗组 (B组 ) ,A组在休克期内只行必要的减压术 ,伤后 3～ 7d行手部切削痂自体皮移植术 (滚轴刀取皮 ) ;B组于伤后 8h内行手部浅层切痂异体皮或生物敷料覆盖术 ,伤后 3～ 5d进行大张自体中厚皮更植(鼓取皮 ) ,指蹼处理上将指蹼缘切开向手背提升 ,以加深指蹼 ,再行皮片插入 ,缝成曲线形 ,创面愈合后各指蹼间隔以条形疤痕贴 ,戴弹力手套并用弹力条布在手套外分指蹼加压 ,晚间应用可塑夹板或行手指牵引对抗疤痕孪缩。结果 :B组在植皮成活率、创面愈合时间等方面优于传统治疗组 ,假蹼发生率下降。结论 :严重烧伤行手部急诊切痂延期植皮为治疗手部深度烧伤较好的方法之一。

Objective: To improve the treatment effect of the serious hand burns.Methods: Divide the 85 serious hand-burn sufferers into group A(the traditional treatment group) and group B(the improved treatment group). In group A, during the 'shock period' of the sufferers, only the necessary pressure-reducing method was used. 3 to 7 days after the wound, we operated on the sufferers by cutting the skin scab and grafting self-skin (getting skins by roller-axis knife). In group B, just 8 hours after the burning accident, quickly cut the scab in the hand and undertaked the hetero-skin grafting or biological-dressing covering. 3 to 5 days after the burning injury, we went ahead with the method of large thick self-skin re-grafting(drum skin-getting method). When dealing with the finger web, we raised the finger web edge to the back of the hand so that it deepensed the finger-web , then sew the new skin slice into the curvaceous shape. When the wound surface was healed, separated each finger-web by stripe-shaped scar healing-strip and try to put pressure on each finger-web at the outside of the glove by the elastic glove and the elastic cloth strip. During the night, used plastic splint or finger traction to counteract the scar contracture. Results: Group B obviously had a better result than group A in the surviving rate and wound healing time, and meanwhile, the occuming rate of false finger web decreased. Conclusion: The emergency hand scab-removing and postponed skin-grafting method is one of the best therapies to treat the sufferers with deep hand burn.