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目的探索手背部深Ⅱ度及深Ⅱ度Ⅲ度混合烧伤的有效治疗方法,旨在更好地恢复手部功能,防止畸形。方法通过对14例25只手背部深Ⅱ度及深度混合伤的削刮痂,保留变性真皮大张薄中厚皮或中厚皮移植,观察皮片成活,手部功能,形态情况观察。结果手背部深Ⅱ度及混合度烧伤保留变性真皮行大张薄中厚皮或中厚皮移植,功能恢复较好,外形基本正常,无出现明显畸形及爪形手。结论对于手部深度烧伤,如何恢复功能,防止畸形,历来在烧伤外科较为重视。传统的削痂及切痂植皮主张去除所有变性坏死组织,创面出学多,止血困难,皮片下易出现淤血,影响皮片成活,愈合后皮肤弹性差,更易产生瘢痕挛缩畸形。本方法不需要止血带,创伤少,渗血少,愈合后皮下弹性好,功能及形状恢复较好。由于保留了自体变性真皮,组织结构与深部组织的连接均优于脱细胞异体真皮移植。手术必须保持无菌操作,必须削除坏死真皮。术前不能行暴露疗法,以防干燥结痂,不利于手术操作。
Objective To explore the effective treatment of deep second degree and deep Ⅱ degree mixed burn in the back of hand and aim to restore the function of the hand better and prevent deformity. Methods The scrape of 14 cases with deep Ⅱ degree and deep mixed injuries on the back of the hand were preserved. The degenerative dermis was kept in the medium or large thickness skin grafts. The survival, the function and the morphology of the skin were observed. Results Deep partial thickness Ⅱ and mixed degree burn retained degeneration of the dermis in large thin or medium thick skin grafts, functional recovery is good, the shape of the basic normal, no significant deformity and claw hand. Conclusion For hand deep burns, how to restore function and prevent deformity has always been more attention in burn surgery. The traditional removal of scab and escharectomy skin grafting advocate the removal of all degenerative and necrotic tissue, the wound more school, bleeding difficulties, easy to appear under the skin congestion, affecting skin survival, skin elasticity after healing is more likely to produce scar contracture deformity. The method does not require tourniquet, less trauma, less bleeding, subcutaneous elasticity after healing, functional and shape recovery better. Due to the retained autologous degeneration of the dermis, tissue structure and deep tissue connections are better than acellular allograft. Surgical operations must be aseptic and necrotic dermis must be removed. Preoperative exposure therapy can not be to prevent dry scab, is not conducive to surgical operations.