上肢深度烧伤的美容整复治疗方法初探

目的:探讨中小面积烧伤患者合并上肢深度烧伤时的手术方案,在最大限度地恢复上肢功能的同时,保持受伤肢体外形的美观。方法:对有上肢深度烧伤且皮源较充足的患者进行早期切削痂,对已形成肉芽创面者则彻底切除或削除创面及其基底板,之后取中厚皮片进行大张皮完整移植,术后10天左右更换敷料并拆线,愈后辅以弹性绷带及功能锻炼等治疗措施巩固疗效。结果:本组共10个病例,13个上肢,最大单侧肢体植皮面积9%,皮片移植的成活率均在95%以上,术后随访2～18个月,患者对功能及外形均表示满意,尚无一例行二次手术矫正。结论:对有上肢深度烧伤但皮源较充足的患者,应提倡进行大张中厚皮完整移植,在保证植皮成功率的基础上,加以术后正确的功能锻炼及弹性绷带等辅助措施,不仅可以最大限度地恢复上肢的功能,同时还可保持肢体外形的美观。

Large and integrity midst-thickness skin autogragh for the patients burned seriously on upper extremity

Objective To discuss the operation skill of the patients with seriously burn on upper extremity in order to reduce the ratio of deformity and keep the outlook utmostly.Methods For the small area burned patients with seriously wound on upper extremity,the eschar and/or granulation would be cut off.Then the midst-thickness skin was got by drum dermatome and transplanted to the wound without any hole on it.After 10 days,the dressing was exchanged at first time.When checking out,the patients were asked to do exercise and wear the elastic bandage for keeping the function and outlook.Results Totally 10 cases(13 upper extremity)were done by this method and the skin taken rate was over 95%.After been traced for 2 to18 months,the patients were satisfied with the function and outlook.No any case was re-operated till now.Conclusion For the patients who had upper extremity burned seriously and had enough donor skin,the large and integrity midst-thickness skin autograph should be the best way to keep the function and outlook at meantime.