Bernstein Michael L, Chung Kevin C
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, USA.
Injury. 2007 Dec;38 Suppl 5:S3-7. doi: 10.1016/j.injury.2007.10.038. Epub 2007 Dec 3.
Mangling injuries to the upper extremity can be devastating, and the early management of these injuries is critical for the success of the reconstruction. These are universally high energy injuries that will need to be taken to the operating room for effective management. Evaluation begins in the emergency department with assessment of vascularity, categorization of damaged structures and assessment of salvageability. There is no role for conservative treatment of these wounds, and once in the operating room, restoration of blood supply and adequate debridement are critical to the ultimate outcome. Removal of damaged, contaminated and devitalized tissues must occur. The goal of early treatment is to create a clean wound ready for reconstruction as soon as possible. Inadequate debridement will only delay reconstruction to the detriment of the patient.
上肢的毁损性损伤可能是灾难性的，而这些损伤的早期处理对于重建手术的成功至关重要。这些损伤无一例外都是高能量损伤，需要送入手术室进行有效处理。评估始于急诊科，包括评估血管状况、对受损结构进行分类以及评估可挽救性。对于这些伤口，保守治疗毫无作用，一旦进入手术室，恢复血供和充分清创对最终结果至关重要。必须清除受损、受污染和失活的组织。早期治疗的目标是尽快创造一个适合重建的清洁伤口。清创不充分只会延迟重建，对患者不利。
