Voche P, Merle M
Service assistance mains, hôpital Jeanne-d'Arc, CHRU Nancy, BP 303, 54201 Toul cedex, France.
Ann Chir Plast Esthet. 2000 Dec;45(6):597-603.
The authors report on their experience of sodium chlorate bomb injuries of the hand observed in seven boys. The thumb was damaged in all cases. This digit was amputated in five cases, was totally saved in one case and partially saved in another case. In four cases, the preservation of damaged tissues in the emergency procedure allowed a secondary reconstruction of the thumb, thus making it possible to achieve a prehensile and sensitive hand. In these former four cases, a posterior interosseous flap was performed to ensure the primary or secondary skin coverage. In two cases, the major lesions necessitated an amputation at the radiocarpal level. In one of these two cases, coverage of the amputated stump by a free gracilis muscle flap made it possible to minimize the level of amputation and to wear a functional prosthesis. Sodium chlorate bombs are made with an unstable chemical mixture. These reactives provoke high-energy injuries with a short range of dispersion. The damages depend on the prehensile mode, which explains why the thumb and the index finger are always injured. These blast injuries were limited to the hand and the skin coverage could be done with a distally based posterior interosseous flap. In spite of the impressive lesions observed in such young patients, a conservative attitude could be taken in an emergency situation with the aim to perform further reconstructive procedures.
作者报告了他们观察到的7名男孩手部氯酸钠炸弹伤的经验。所有病例中拇指均受损。5例拇指被截肢，1例拇指完全保留，另1例部分保留。4例在急诊手术中保留受损组织，使得拇指能够二期重建，从而有可能获得具有抓握功能且感觉灵敏的手。在这前4例中，采用骨间后皮瓣来确保一期或二期皮肤覆盖。2例因严重损伤需要在桡腕关节水平截肢。在这2例中的1例，采用游离股薄肌皮瓣覆盖截肢残端，使得截肢平面降至最低，并能佩戴功能性假肢。氯酸钠炸弹由不稳定的化学混合物制成。这些反应物引发高能损伤，且分散范围短。损伤取决于抓握方式，这就解释了为什么拇指和示指总是受伤。这些爆炸伤仅限于手部，可采用远端蒂骨间后皮瓣进行皮肤覆盖。尽管在如此年轻的患者中观察到严重损伤，但在紧急情况下可采取保守态度，以便进行进一步的重建手术。
