Duteille F, Bellier-Waast F, Perrot P
Centre des brûlés, service de chirurgie plastique et reconstructrice, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France.
Ann Chir Plast Esthet. 2011 Oct;56(5):382-7. doi: 10.1016/j.anplas.2011.08.013. Epub 2011 Oct 1.
The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. The authors with their experience combined to a review of the literature, try to clarify these indications for each anatomical location. From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.
在烧伤后遗症的治疗中使用显微外科手术并非新思路，自20世纪70年代以来，游离皮瓣就已在此背景下被应用。负压治疗和皮肤替代物等新技术确实减少了游离皮瓣的应用指征。作者结合自身经验并回顾文献，试图阐明每个解剖部位的这些指征。从技术角度来看，他们发现为这些患者实施游离皮瓣更为复杂（静脉损伤、缺乏未烧伤的供区……）。尽管如此，显微外科手术仍必须纳入决策流程，并且对于手部重建存在一些不可替代的指征。
