Barillo D J, Arabitg R, Cancio L C, Goodwin C W
Division of Plastic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 426, Charleston, SC 29425, USA.
Burns. 2001 Sep;27(6):613-9. doi: 10.1016/s0305-4179(01)00014-6.
Burns to the hand that are complicated by exposure of bone, joint or tendon cannot be closed with conventional skin grafts and require flap procedures to prevent further damage. Local or regional flaps may be unavailable if electrical or blast trauma produces a large zone of injury, or when forearm burn injury extends beyond fascia. Free tissue transfer may not be tolerated by critically ill burn patients. In these circumstances, distant pedicle flaps are one option for safe and effective soft tissue coverage. Over a 5-year period, we have performed six distal pedicle flaps for coverage of exposed hand structures when local or free flaps were contraindicated or unavailable. The patients required an average of 4.5 surgical procedures to complete hand reconstruction and soft tissue coverage. Soft tissue coverage was completely successful in five patients and partially successful in one patient. Single stage local or free flaps remain the treatment of choice when burned hands cannot be covered with skin grafts. When these flap options are not available, distant pedicle flaps provide a safe alternative.
手部烧伤若伴有骨骼、关节或肌腱外露，则无法用传统皮肤移植进行闭合，而需要采用皮瓣手术以防止进一步损伤。如果电烧伤或爆炸伤造成大面积损伤，或者前臂烧伤累及深筋膜以外区域，可能无法采用局部或区域皮瓣。重症烧伤患者可能无法耐受游离组织移植。在这些情况下，远位蒂皮瓣是实现安全有效软组织覆盖的一种选择。在5年期间，当局部皮瓣或游离皮瓣禁忌使用或无法使用时，我们采用了6例远位蒂皮瓣来覆盖手部外露结构。患者平均需要4.5次外科手术来完成手部重建和软组织覆盖。5例患者的软组织覆盖完全成功，1例部分成功。当烧伤的手部无法用皮肤移植覆盖时，一期局部或游离皮瓣仍然是首选治疗方法。当这些皮瓣选择不可用时，远位蒂皮瓣提供了一种安全的替代方案。
