Grube B J, Engrav L H, Heimbach D M
Department of Surgery, University of Washington, Seattle.
J Trauma. 1992 Nov;33(5):662-4. doi: 10.1097/00005373-199211000-00011.
Traditional treatment after grafting of foot, ankle, and lower leg burns is bedrest, limb elevation, and gradual ambulation only after 5 to 10 days. In 1982 we suggested that aggressive surgical treatment and early ambulation could shorten hospital stay and decrease morbidity. Our treatment of these burns is excision and grafting, application of an Unna (dome paste) boot immediately in the operating room or the next morning, with normal ambulation 4 hours later and discharge of the patient if there are no other reasons for continued hospitalization. This paper reports the continuation of this plan in 100 patients treated since 1982 with a mean age of 28.8 +/- 16.9 (SD) years and burn size of 3.7% +/- 4.4%. Sheet grafts were applied to 64% with a 96% take and narrowly meshed grafts to 36% with a 97% take. Results were excellent in 85 patients, satisfactory in ten, and poor in three who required another graft. Return to work was in 4.7 +/- 3 weeks. Unna boot application permits immediate ambulation, avoids frequent dressing changes, permits a brief or no hospital stay, and provides excellent graft take with prompt return to work.
足部、踝关节及小腿烧伤植皮后的传统治疗方法是卧床休息、抬高肢体，仅在5至10天后逐渐开始行走。1982年我们提出积极的手术治疗和早期行走可缩短住院时间并降低发病率。我们对这些烧伤的治疗方法是切除并植皮，在手术室或次日早晨立即应用Unna（圆顶糊剂）靴，4小时后即可正常行走，若无其他继续住院的原因则可让患者出院。本文报告了自1982年以来对100例患者实施该方案的情况，这些患者的平均年龄为28.8 +/- 16.9（标准差）岁，烧伤面积为3.7% +/- 4.4%。64%的患者采用了整张植皮，成活率为96%；36%的患者采用了窄幅网状植皮，成活率为97%。85例患者效果极佳，10例患者效果满意，3例患者效果不佳，需要再次植皮。患者在4.7 +/- 3周后重返工作岗位。应用Unna靴可立即行走，避免频繁换药，可缩短住院时间或无需住院，并能使植皮良好成活，患者可迅速重返工作岗位。
