Pradier Jean-Philippe, Oberlin Christophe, Bey Eric
Plastic and Maxillo-Facial Surgery Service, Centre de Traitement des Brûlés, Hôpital d'instruction des Armées Percy, Clamart, France.
J Burns Wounds. 2007 Jan 16;6:e1.
We evaluated the long-term outcome of the "pocket flap-graft" technique, used to cover acute deep burns of the dorsum of the hand, and analyzed surgical alternatives.
This was a 6-year, retrospective study of 8 patients with extensive burns and 1 patient with a single burn (11 hands in all) treated by defatted abdominal wall pockets. We studied the medical records of the patients, and conducted a follow-up examination.
All hands had fourth-degree thermal burns caused by flames, with exposure of tendons, bones, and joints, and poor functional prognosis. One third of patients had multiple injuries. Burns affected an average of 36% of the hand surface, and mean coverage was 92.8 cm(2). One patient died. The 8 others were seen at 30-month follow-up: the skin quality of the flap was found to be good in 55% of the cases, the score on the Vancouver Scar Scale was 2.4, the Kapandji score was 4.5, and total active motion was 37% of that of a normal hand. Hand function was limited in only 2 cases, 8 patients were able to drive, and 3 patients had gone back to work.
The pocket flap-graft allows preservation of hand function following severe burns, when local or free flaps are impossible to perform. Debulking of the flap at the time of elevation limits the need for secondary procedures.
我们评估了用于覆盖手背急性深度烧伤的“袋状皮瓣移植”技术的长期疗效，并分析了手术替代方案。
这是一项为期6年的回顾性研究，对8例大面积烧伤患者和1例单次烧伤患者（共11只手）采用脱脂腹壁袋进行治疗。我们研究了患者的病历，并进行了随访检查。
所有手部均为火焰导致的四度热烧伤，伴有肌腱、骨骼和关节外露，功能预后较差。三分之一的患者有多处损伤。烧伤平均累及手部表面积的36%，平均覆盖面积为92.8平方厘米。1例患者死亡。其余8例在30个月随访时：55%的病例皮瓣皮肤质量良好，温哥华瘢痕量表评分为2.4，卡潘迪评分为4.5，总主动活动度为正常手的37%。仅2例手部功能受限，8例患者能够开车，3例患者已重返工作岗位。
当无法进行局部或游离皮瓣手术时，袋状皮瓣移植可在严重烧伤后保留手部功能。抬高时对皮瓣进行减容可减少二次手术的需求。
