烧伤后爪形手畸形的整复

目的 探讨烧伤后爪形手畸形的整复方法. 方法 1992年5月-2007年5月,笔者对97例(136只患手)烧伤后爪形手畸形患者进行手术整复,患手中,轻度畸形21只、中度92只、重度23只;手背创面植皮修复104只患手,皮瓣转移修复32只患手.掌指关节复位在手背部瘢痕组织充分松解后主要采用手法拔伸牵引复位,必要时松解侧副韧带、背侧关节囊和分离关节内粘连,肌腱挛缩明显者行肌腱延长术.手背瘢痕松解整复后根据情况行手指屈曲畸形整复、指蹼和虎口粘连松解植皮、指伸肌腱中央腱修复或指间关节融合术.31例患者因手指屈曲畸形严重,阻碍掌指关节复位,先行手指掌侧瘢痕松解植皮,再行手背瘢痕松解、掌指关节复位、皮瓣转移或植皮.术后采取综合康复治疗措施. 结果术后皮片全部成活;4只患手皮瓣远端边缘因瘢痕组织部分坏死,换药后愈合,其余皮瓣完全成活.患手绝大部分关节畸形完全或基本纠正,对掌、握拳功能恢复或部分恢复,效果较为满意. 结论个性化、系统全面地进行皮片移植和皮瓣转移是整复烧伤后爪形手的关键.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.     

预扩张全厚皮片移植修复全手背瘢痕挛缩

目的总结采用预扩张全厚皮片修复全手背瘢痕挛缩切除后继发创面的疗效。方法 2008年2月-2011年2月,收治全手背瘢痕挛缩患者15例(19手)。男12例(14手),女3例(5手);年龄18～43岁,平均28.6岁。瘢痕形成时间6～22个月,平均13.2个月。均伴不同程度掌指关节背伸畸形和指间关节屈曲畸形。一期在拟供皮处植入软组织扩张器,注水扩张4～5个月;二期切除瘢痕后缺损范围为14 cm×9 cm～25 cm×16 cm,采用预扩张全厚皮片修复创面。结果一期术后除1例患者扩张皮瓣中央皮肤部分缺血坏死外,其余扩张皮瓣均血运良好。二期术后18手皮片成活;1手可见散在表皮下积液,给予引流后愈合。供区切口愈合良好。患者均获随访,随访时间6～18个月,平均13.7个月。皮片光滑平整,色泽质地优良,弹性良好,皮片边缘及接缝处无明显瘢痕形成。手部功能恢复良好,腕关节、掌指关节及各指间关节屈伸正常。结论采用预扩张全厚皮片修复全手背瘢痕切除后继发创面,术后手部外观及功能恢复良好。     

腹部皮瓣瓦合足背皮瓣修复手部严重皮肤脱套伤

目的报道利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤的手术方法及，临床疗效。方法2003年2月～2010年6月．收治手部严重脱套伤患者9例。彻底清创后2—5指末节或中节中部平面以远指骨截除，创面先采用腹部带蒂皮瓣包埋手部创面，3～4周后行腹部皮瓣断蒂，并用腹部皮瓣覆盖手（指）背侧创面，游离足背皮瓣修复手（指）掌侧创面，足背供区行游离植皮术。皮瓣成活后3个月、6个月分别行手指分指术。结果术后9例手掌、手背皮瓣均顺利成活，伤口均一期愈合，足部供区植皮区及腹部供区伤口一期愈合。随访以最后一次分指术后开始计算，时间为6～48个月．平均15个月。手掌、手背皮瓣无臃肿。2—5指掌指关节活动为0°-80°，指间关节僵直于伸直位，2—5指可完成与拇指的对指、对捏等功能。手（指）背皮瓣感觉恢复为S1-S2，手（指）掌皮瓣感觉恢复为S2～S3＋。足背供区及腹部无明显瘢痕挛缩，行走无明显影响。结论利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤，可以修复手部创面，重建手部分功能，是一种较好的治疗方法。     

手瘢痕挛缩畸形整形疗效分析

目的:探讨手瘢痕挛缩畸形手术整形临床效果。方法:2012年3月-2015年10月收治47例(73手)手部瘢痕挛缩畸形患者。手术切除部分或全部瘢痕组织,松解瘢痕挛缩,自体全厚皮移植修复创面。条索状瘢痕、指蹼及虎口处松解瘢痕挛缩后,用V-Y、Z形皮瓣、五瓣等局部皮瓣开大虎口、加深指蹼。结果:7只手因小指或示指指间关节瘢痕挛缩重,无法完全矫正,余手部畸形完全矫正。随访2~24个月,5只手因皮片挛缩,再次出现手瘢痕挛缩畸形。余手部功能恢复良好,皮瓣及皮片质地软,弹性良好。结论:局部皮瓣及全厚皮移植修复手瘢痕挛缩畸形临床效果好;为防止瘢痕挛缩重致畸形难以完全矫正,需早期手术。     

掌指关节关节囊掌板紧缩术治疗爪形手畸形

目的探讨掌指关节关节囊掌板紧缩术治疗爪形手畸形的疗效.方法将爪形指畸形的掌指关节的掌板舌形瓣状向近端切开掀起,用骨刀在掌骨颈处做粗糙面,将掌指关节屈曲60°位,于掌板近端U形穿过钢丝,通过注射器针头自掌骨两侧向背侧引出钢丝两端,在手背皮肤外打包拉紧钢丝,用无损伤线紧缩缝合掌板及关节囊.术后屈曲掌指关节,伸直指间关节石膏固定6周.去石膏后进行主动功能练习,10周后被动伸直掌指关节.结果用此方法治疗爪形手畸形15例,随访12例,其中优2例,良8例,差2例.结论应用此法治疗爪形手畸形,要充分了解手术适应证及影响爪形手畸形矫正的因素,以达到良好的治疗结果.     

手部骨间肌功能重建术

手部骨间肌麻痹的功能重建,如有可供动力肌腱移位的条件,应争取施行动力肌腱移位重建骨间肌的功能,以便使伤手恢复主动的屈掌指关节和伸指间关节的功能,恢复伤手有效的捏物功能,同时也纠正了手的爪形畸形.只有当没有条件施行动力肌腱移位修复骨间肌功能,才考虑施行掌指关节掌板固定术,以控制掌指关节不过伸,使指总伸肌的伸指力量更容易传达到手指,发挥伸指的作用.但这种手术的效果仅能纠正手的爪形畸形,不能做主动的屈掌指关节和伸指间关节的动作,仍不能有效地解决手的捏物功能.     

游离桡动脉掌浅支皮瓣修复手指近指间关节严重屈曲挛缩畸形

目的:探讨应用游离桡动脉掌浅支皮瓣修复手指近指间关节屈曲挛缩畸形临床疗效。方法:2017年2月-2019年2月,对7例手指近指间关节屈曲挛缩瘢痕患者进行松解,并将近指间关节固定于伸直位,同时采用游离桡动脉掌浅支皮瓣覆盖创面。术后3周拆去内固定开始功能锻炼。结果:术后随访6～19个月,腕部供区外观影响小,皮瓣柔软,手指近指间关节活动依据TAM标准,5例优,2例良。结论:游离桡动脉掌浅支皮瓣修复手指近指间关节屈曲挛缩畸形可获得满意的功能及外形,是一种较好的临床治疗方法。     

手指瘢痕挛缩屈曲畸形的矫正

手指瘢痕挛缩屈曲畸形是手部烧伤后较为常见的一种畸形,多见于儿童,可一指或多指,手指掌侧有条索状或蹼状瘢痕,手指掌指关节、指间关节屈曲挛缩,并常向一侧扭曲,以近指间关节最为严重（图１）。手指长期的屈曲挛缩,可导致深部血管、神经、肌腱的短缩,关节囊、韧带的挛缩,在儿童期由于指间关节长期处于屈曲位,使近节指骨头关节面掌侧长期受压,影响指骨头的发育,可导致指骨头的过度掌倾,这将影响手指松解后的效果和关节的稳定活动。手指屈曲挛缩的矫正,一般矫正至掌指关节、近指间关节屈曲３０°位即可,即满足功能和外观的要求…     

拉长式弹性牵引矫治烧伤后爪形手畸形

目的 探讨修复烧伤后爪形手畸形的新途径.方法 2006年5月至2010年7月,对12例瘢痕切除松解植皮或皮瓣移植术后畸形矫正不满意的烧伤爪形手,应用个性化手功能支具结合橡皮筋、指端克氏针(或粘胶带)对手指进行拉长式弹性牵引.结果 术后随访0.5～2年,弹性牵引对烧伤爪形手中存在的掌指关节过伸畸形、近侧指间关节屈曲畸形、虎口挛缩均有效果,可将屈曲短缩的手指拉长,也有利于掌弓复位.少部分(8/28)拉长复位的近侧指间关节屈曲畸形复发或关节不稳,需关节融合.结论 拉长式弹性牵引是矫治烧伤后爪形手畸形的有效方法,损伤小,效果较稳定.

Abstract：

Objective To investigate a new method for correction of claw hand deformity after burns. Methods From May 2006 to Jul. 2010, 12 patients with claw hands deformities after burns were treated with skin grafts (11 hands) and skin flap(1 hand) with unsatisfactory results. Then elastic traction (skin traction or skeletal traction) were performed with individual functional brace. Results All patients were followed up for 0. 5 to 2 years. Elastic traction was effective in the correction of metacarpophalangeal joint deformity, buttonhole deformity, thumb-in-palm deformity, scar contracture, and palmar arch deformity. Conclusions Elastic traction is a simple and effective way for the correction of claw hand deformity after burns with less morbidity and stable results.     

腹部双蒂真皮下血管网皮瓣修复手部脱套伤

目的　总结腹部双血管蒂真皮下血管网皮瓣急诊修复手部脱套伤的效果。方法1994年～1997 年对19 例手部脱套伤,急诊采用腹壁下动脉为蒂的薄皮瓣和腹壁浅动脉为蒂的薄皮瓣进行瓦合修复。结果　术后皮瓣全部成活。随访1～3年,手外形美观,皮瓣质地柔韧,伸指正常,拇指对掌功能正常。掌指关节屈曲45°～60°,近指节关节屈曲10°～25°,生活自理。结论　采用腹部双血管蒂真皮下血管网皮瓣修复手部脱套伤具有皮瓣移位后血循环好,抗感染力强,成活率高,修复后手外形美观,不臃肿等特点。     

The abdominal flap using scarred skin in the treatment of postburn hand deformities of severe burn patients

PURPOSE: To present a random-pattern flap technique using scarred skin from the abdominal wall to cover the defect after burn scar was released from the hand and the scarred skin raised from the hand was transferred to the abdominal wall to cover the flap-donor area in patients who suffered from severe burns involving the entire body and had no available healthy skin to be used for coverage. METHODS: Ten hands of 7 patients (5 males, 2 females) were treated in our department between April 1994 and February 2001. The total body surface area involved with second-or third-degree burns was 85% to 96% and there was no available healthy skin to be used for reconstruction. All hands had severe scar contracture on the dorsum and lost most of their function and the patients lost the ability to take care of themselves. The scarred skin on the dorsum of the hand was elevated integrally as a flap based on the ulnar border of the hand. The tendons were released, the stiff metacarpophalangeal joints were mobilized by closed capsulotomies, and the contracture of the thumb web space was released. A random-pattern abdominal flap using scarred skin was designed and elevated to cover the defect of the scar-released hand and the scarred skin raised from the dorsum of the hand was transferred to cover the defect of the abdominal flap donor site. RESULTS: The flaps that were transferred to the dorsum of the hands survived entirely and the defects of the flap donor area were covered perfectly without further skin graft. All patients were evaluated for 0.5 to 4 years after surgery. The range of motion of the metacarpophalangeal joints and the space capacity of the thumb web were improved greatly. All patients regained the ability to take care of themselves. CONCLUSIONS: This method is simple and has satisfactory results. It appears from our experience that the mature postburn scarred skin on the abdomen can be used for a flap procedure for reconstructing the burned hand and that the scarred skin raised from the dorsum of the hand can be transferred to cover the flap donor sites on the abdomen. Under circumstances in which there is no normal skin for reconstruction the function of the burned hand could be improved greatly by this method.     

腹部扩张真皮下血管网皮瓣修复手背瘢痕的临床研究

目的探讨应用腹部扩张真皮下血管网皮瓣修复手背及手指背侧大面积瘢痕的方法及临床疗效。方法 2005年5月-2010年10月,收治16例手背及手指背侧瘢痕患者。男13例,女3例;年龄10～35岁,平均22.5岁。致伤原因:烧伤10例,热压伤4例,烫伤2例。瘢痕形成1年6个月～2年,平均21个月。患者掌指关节与指间关节屈曲受限,瘢痕范围为11 cm×7 cm～18 cm×10 cm。一期行腹部扩张器置入术;注水完成2周后行二期手背瘢痕切除、扩张皮瓣带蒂移位修复术,扩张皮瓣范围为12 cm×9 cm～19 cm×12 cm;二期术后14 d行三期皮瓣断蒂以及手指分开、指蹼成形。腹部供区直接拉拢缝合。结果术后皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。16例患者均获随访,随访时间1年2个月～3年,平均2年3个月。皮瓣质地柔软,弹性佳。末次随访时手功能按手部指关节主动活动(TAM)法评定:获优13例,良2例,差1例;优良率93.7%。结论腹部扩张真皮下血管网皮瓣血供重建速度快、成活面积大、质地良好,是修复手背大面积瘢痕的较好方法。     

有血运关节移植再造掌指关节

目的　探讨与比较再造手部关节缺损的方法 ,报道不同关节及关节瓣移植的临床效果。　方法　应用吻合血管的跖趾关节移植 5例、跖趾关节皮瓣移植 5例、趾间关节瓣移植 2例、趾间关节皮瓣移植 2例 ,同一血管蒂带跖趾关节与趾间关节复合瓣一期重建相邻两掌指关节 1例 ,带血管蒂残存掌指关节瓣转移 2例。共再造掌指关节 17例 18个。结果　全部组织瓣存活。经平均 2年 3个月 (6个月～ 7年 )随访 ,再造掌指关节平均活动度为 5°～ 5 6°(范围 15°～ 85°) ;出现骨不连接和关节畸形各 1例。　结论　有血运关节移植再造掌指关节 ,术后功能与外形恢复良好 ,但总体疗效仍有待提高。     

Reconstructive hand surgery for scleroderma joint contractures

Systemic scleroderma can cause significant hand deformity and functional impairment. Surgery is often avoided due to the perceived risks of wound healing. The most common surgical procedures have been digital sympathectomy, arthrodesis or arthroplasty of the proximal interphalangeal (PIP) or both, and metacarpophalangeal (MCP) joints. We describe herein successful soft tissue hand surgery in 2 patients for treatment of scleroderma claw deformities without the use of arthrodesis or arthroplasty. At the MCP joint, the tight capsules were excised, and the collateral ligaments and volar plates were released. At the PIP joints, the volar plates were released and the tight palmar skin was released, resulting in marked improvement of joint position. Intensive hand therapy was used to maximize function. In these 2 patients with claw deformity, we found that tight volar skin was the main contributor to flexion contracture at the PIP level. In contrast, joint capsule contracture was the main contributor to hyperextension deformity at the MCP level.