Burm J S, Oh S J
Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea.
Plast Reconstr Surg. 2000 Feb;105(2):581-8. doi: 10.1097/00006534-200002000-00016.
The fundamental problem in all types of hand burns is a loss of skin and subsequent deformities. The goal of skin grafting on the dorsal hand is to graft a sufficient amount of skin, as much as the original amount, and to restore normal hand function without secondary deformities. The safe, or Michigan, position commonly has been used for immobilizing the hand. However, this position is to protect hand function rather than to provide for adequate skin grafting. This institution has developed a new hand position (the fist position) for grafting the greatest amount of skin on the dorsal side of the hand. In the fist position, the hand is positioned flexing all joints of the wrist and the fingers and maximally stretching the dorsal surface of the hand before skin grafting. Ten hands with deep second- or third-degree burn (n = 6) and burn scar contracture (n = 4) of the dorsal hand in eight patients were treated with split-thickness skin grafting after immobilizing in the fist position. The burns and contractures involved nearly the total area of the dorsal hand. The hand was kept in the fist position for 7 to 9 days after skin grafting. Excellent functional and cosmetic results were observed in all cases during the follow-up period of 6 months to 2 years. Complications resulting from hand immobilization for a short period did not occur. The fist position may be a proper hand position for skin grafting to reconstruct the dorsal hand.
各类手部烧伤的根本问题在于皮肤缺失及随后出现的畸形。在手背进行皮肤移植的目的是移植足够量的皮肤，达到与原来皮肤量相当的程度，并恢复手部正常功能且不产生继发性畸形。安全位，即密歇根位，通常被用于固定手部。然而，这个位置是为了保护手部功能，而非为充分的皮肤移植提供条件。本机构开发了一种新的手部姿势（握拳位），用于在手背移植最大量的皮肤。在握拳位时，手部在进行皮肤移植前，将腕关节和手指的所有关节屈曲，最大程度地伸展手背的皮肤表面。8例患者的10只手存在手背深二度或三度烧伤（n = 6）以及烧伤瘢痕挛缩（n = 4），在固定于握拳位后进行了中厚皮片移植。烧伤和挛缩几乎累及了整个手背面积。皮肤移植后，手部保持握拳位7至9天。在6个月至2年的随访期内，所有病例均观察到了优异的功能和美容效果。未发生因短期手部固定导致的并发症。握拳位可能是用于手背重建皮肤移植的合适手部姿势。
