Young R C, Burd A
Division of Plastic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR.
Burns. 2004 Nov;30(7):723-8. doi: 10.1016/j.burns.2004.03.017.
The aim of this study was to assess the functional outcome in children who had undergone release of upper limb burn contractures at the axilla, elbow and wrist.
We studied a series of 10 patients reconstructed with local flaps (n = 5), Integra artificial skin (n = 10) and micro-vascular free tissue transfer (n = 5) to release contracted axillae (n = 8), elbows (n = 5) and wrists (n = 7). Follow-up ranged from 6 months to 6 years and outcome was assessed by functional improvement.
Full functional release was achieved in all cases at the time of the surgery. Local flaps resulted in good or excellent outcomes in all five cases. Six patients reconstructed with Integra were assessed as having an excellent outcome whereas four had a poor outcome. Free tissue transfer with excellent result was achieved in five children.
This series assessed the three treatment options that we have used for the release of upper limb post-burn contractures. We have shown that local flaps fashioned from burnt skin survive, Integra requires extended post-operative care to prevent recontraction and free tissue transfer is safe in young children. Each method when used appropriately has produced excellent results which have been maintained over the follow-up period.
本研究旨在评估接受腋窝、肘部和腕部上肢烧伤挛缩松解术的儿童的功能结局。
我们研究了一系列10例患者，分别采用局部皮瓣（n = 5）、Integra人工皮肤（n = 10）和微血管游离组织移植（n = 5）来松解挛缩的腋窝（n = 8）、肘部（n = 5）和腕部（n = 7）。随访时间为6个月至6年，通过功能改善情况评估结局。
所有病例在手术时均实现了完全的功能松解。所有5例采用局部皮瓣的患者结局良好或优秀。6例采用Integra人工皮肤重建的患者被评估为结局优秀，而4例结局较差。5例儿童采用游离组织移植取得了良好效果。
本系列研究评估了我们用于上肢烧伤后挛缩松解的三种治疗选择。我们已表明，由烧伤皮肤制成的局部皮瓣能够存活，Integra需要延长术后护理以防止再次挛缩，游离组织移植对幼儿是安全的。每种方法在适当使用时均产生了优异的效果，并在随访期间得以维持。
