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yxfbbiedtj · Wysłany: Sob 10:29, 05 Mar 2011

Hand burn scar contracture deformity after surgical restoration

Reconstructive surgical treatment. Are as follows. 1 clinical data in this group fell 41 male and female 29 cases; total of 1l3 hand. Reconstructive surgery after injury from the time of 3 months to l6 years, which has been in cutting, tangential excision surgery in 45 cases, 25 patients without surgery. Malformation type: ① Light: finger web adhesions, mild contracture of the palm, finger flexion or wrist dorsiflexion. But no tendon damage and reduced blood vessel. ② Medium: claw hand. Metacarpophalangeal joint dorsiflexion. Interphalangeal joint flexion, adductor pollicis, palmar arch disappeared, can not make a fist. And with tendon damage and blood vessels and nerves shortened. ③ Heavy extremely severe dorsiflexion contracture deformity of the fingers with joint dislocation,[link widoczny dla zalogowanych], or a finger defects and shortened. Severe wrist dorsiflexion, and bone and joint damage. The group of 75 hand-light, medium, 29 hands, 2 heavy hand of nine surgical methods in this group formed or five words with z plasty 61 hands, close to local rotation flap + skin graft 43 hand. Flap + skin graft + hand arthrodesis 9. Operation points: ① scar excision: scar was separated from the superficial fascia, and completely removed, exposing the healthy tissue without scar record base. Adjacent to the tendon can be exposed by soft tissue coverage, the incision should be along the side of the finger sticks and large, jagged line of small fish should be cut at the occasion. The incision should not shorter than 1cm. ② skin grafting: should use the thick or full-thickness skin coverage, and as complete as possible, to avoid splicing in the functional area. Appropriate extension of time to disconnect after 10 ~ l5 days. ③ thumb adduction deformity: a thumb adductor contracture, should cut the contracture of the deep fascia, if necessary, the proximal phalanx in the thumb adductor grumble at the cutting head to deepen the jaws of death cross. ④ scar on the finger web at the flap should be used to repair the surrounding tissue. ⑤ to completely reset the metacarpophalangeal joint,[link widoczny dla zalogowanych], if necessary, cut off the test collateral ligament, dislocated joints possible serious financial units. @ Barely extended beyond its borders not finger flexion 180. To avoid the finger distal necrosis. ⑦ injured arm bandaged after surgery or cast immobilization on the functional spaces. 3 results of therapeutic efficacy: complete satisfaction showed deformity correction and other functions on the master boxing a good recovery; relatively satisfied with the basic display deformity correction, there are minor obstacles to boxing on the master; can still show some correction of deformity, functional part of the recovery. Light in this group were satisfactory restoration surgery; medium and heavy cases satisfactory in 29 cases, 5 were satisfied down, can still be cases. q Summary of Discussions in this group, we believe that the hand marks cancer. Once the cause contracture affecting function, surgery should be immediately, without waiting for scars to soften, so as not to increase the deformity, affecting the entire complex effects. Surgery should be noted; ① complete removal of scar tissue in the same time, healthy tissue as possible to retain the deep, so that skin grafting area full, flexible, good shape. ② In order to ensure a clear operative field, which will help surgical operation required on the tourniquet tourniquet time should be controlled in 1 hour, more than this time surgery is not done, should be stopped for 15 minutes to relax tourniquet. ③ As long scar stretching, organizations can lose their normal structure and location, especially the blood vessels, nerves and so on. Therefore, patients should avoid injury. Ligament blood vessels near the side away from the mean,[link widoczny dla zalogowanych], cut with care. ④ fingers can not be forced palmar flexion extension, especially in the sample vessel was bowstring taut, the fingers so as not to affect the distal blood supply. @ Skin graft fixation should be accurate, and dressing should be strong, pressure to moderate, not too tight,[link widoczny dla zalogowanych], and the fingers to expose distal to observe the finger blood flow. ⑥ malformation complex are required for individual sub-second operation in different parts of the entire complex of persons, not to bite off more than one operation, so as not to affect the outcome. ⑦ conditions should try to use whole, covered in thick skin graft over the wound, because the thin film or stamp-like skin grafts can cause late deformity. Source of large area burn the skin tight. Decompression as soon as possible and fixed the injured arm in the 【19970615 Received infection control pulse may be narrow flap. At this point simply close the ventricular septal defect, such as would cause severe left ventricular failure. Subaortic stenosis degree is closely related with age, with age and duration of the extension, the disease developed in 16 * sexual orientation. Subvalvular aortic stenosis by the flow of jet deformation can be thickened, and even valve stenosis and regurgitation. So. Just diagnosed,[link widoczny dla zalogowanych], should be implemented as early surgery. (19970j13 Received)