Richard Reginald L, Lester Mark E, Miller Sidney F, Bailey J Kevin, Hedman Travis L, Dewey William S, Greer Michelle, Renz Evan M, Wolf Steven E, Blackbourne Lorne H
United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
J Burn Care Res. 2009 Jul-Aug;30(4):625-31. doi: 10.1097/BCR.0b013e3181ac016c.
The development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.
烧伤瘢痕挛缩的形成部分归因于自然柔软的皮肤被数量和质量均不足的可伸展瘢痕组织所替代。与肢体活动范围（ROM）相关的特定皮肤表面区域容易形成烧伤瘢痕挛缩，从而阻碍关节的完全ROM，导致畸形、功能障碍和残疾。先前的研究记录了与腕关节伸展相关的前臂皮肤运动。本研究的目的是将与ROM相关的皮肤运动识别范围扩展到所有容易形成烧伤瘢痕挛缩的关节表面区域。20名未烧伤的男性受试者进行了人体测量，并在其躯干和优势肢体上标记了皮肤。每个受试者对九个常见的烧伤瘢痕挛缩部位进行活动范围测试，在活动开始和结束时拍摄标记。记录与关节ROM相关的皮肤运动面积，进行归一化处理，并量化为总面积的百分比。平均而言，受试者从规定区域募集了83%的可用皮肤来完成所有感兴趣关节的运动（范围为18 - 100%）。腕关节屈曲时皮肤的募集在受试者之间表现出最大的变异性，而膝关节伸展时皮肤的募集表现出最大的一致性。未发现皮肤运动与体脂百分比或体重指数之间存在关联。皮肤募集与关节ROM呈正相关。识别出与正常ROM相关的皮肤区域，随后将其标记为皮肤功能单位。参与关节运动的皮肤面积远远超出关节皮肤褶皱本身的紧邻区域。这些信息可能会影响重度烧伤患者康复计划的设计。
