手部烧伤瘢痕挛缩畸形整复.doc

手部烧伤瘢痕挛缩畸形整复 　 作者：林闻海， 郑廷忠， 王庆生， 蔡立伟 【关键词】 挛缩畸形 摘要：目的：探讨手部烧伤后瘢痕挛缩畸形较为有效的防治方法。方法：对2000年6月至2004年12月间74例手烧伤后瘢痕挛缩畸形产生的主要原因、整复方法及疗效进行回顾性分析。结果：74例手烧伤后瘢痕挛缩畸形产生的主要原因为：①创面早期处理不当致感染加深；②深II度烧伤病人不接受植皮而形成增生性瘢痕；③深度烧伤创面手术时间晚或薄皮片移植及术后未进行康复锻炼。整复手术采用瘢痕松解植皮、局部成形、皮瓣转移、关节融合等方法，术后采用抗挛缩措施并加强功能锻炼。随访67例73只手，3例手指掌侧瘢痕挛缩松解植皮后再挛缩行二次手术；3例虎口、指蹼处缝线瘢痕挛缩，其中1例影响功能需二次手术；所有畸形关节完全或基本矫正；功能恢复满意。结论：手部烧伤早期正确治疗可有效预防瘢痕增生，对继发手瘢痕畸形者及早行瘢痕彻底松解，植皮或局部成形、皮瓣修复，加强术后康复治疗能取得良好疗效。 　　关键词: 手； 瘢痕； 挛缩畸形； 整复术 　　The Deformed Restitution of Hand Burn Scar Contracture 　　Abstract : Objective : To explore the effective prevention and cure methods in Deformed restitution of hand burn scar contracture. Method: To retrospectively analyse the main reasons restitution measures and curative effect in 74 cases with hand burn scar contracture from June 2000 to December 2004. Result: The reasons of hand burn scar contracture in 74 cases included deepened infection due to inappropriate treating the wound surface in the early stage, the form of hyperplastic scar due to failing to accept the dermoplasty in deep II burn and late operation or thin free skin graft in deep burn and inadequate rehabilitation exercise after operation. Restitution with solution dermoplasty, transfer of skin flap, fusion of joint, anticontracture measures and functional exercise were performed in the cases. 4 cases needed the second operations because of scar recontracture of the finger palm in 3 cases and dysfunction due to suture line cicatricial contracture in hukou and fingerweb in 1 cases. all of the deformed joints completely or almost become well . patients recovered satisfactorily after follow up the 73 hands of 67 cases. Conclusion: Hyperplastic scar can be effectively prevented in the early stage after hand burn, early scar solution, thoroughly and sking rafting, skin flap reparation strengthened rehabilitative treatment to the secondum scar contracture deformed do benefit in curative effect. 　　Key words Hand; Scar; Contracture deformed; Restitution 　　手部烧