Logan S E, Bunkis J, Walton R L
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Int Surg. 1990 Apr-Jun;75(2):109-14.
A series of 27 blast and gunshot injuries of the hand is presented. These wounds exhibit a spectrum of complexity and may include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and amputations. A systematic management sequence is outlined to evaluate, treat, reconstruct and rehabilitate these hands, with the primary goal of obtaining early maximal function. Since these injuries vary in nature and complexity, this management sequence is specifically adapted to deal with the individual injury. A "reconstructive ladder" of techniques is utilized, ranging from "simple" (e.g., direct closure, skin grafts, local flaps) to "complex" (free flaps, toe-to-thumb transfer). The individual procedure selected is the most straightforward, consistent with expediency and early return of a functional hand. The return of these hands to function has been facilitated by recent advances in tissue assessment, free tissue transfer, and skilled hand therapy.
本文介绍了27例手部爆炸伤和枪伤。这些伤口呈现出一系列复杂性，可能包括广泛的软组织创伤，并伴有烧伤、异物、骨折和截肢。概述了一个系统的处理流程，用于评估、治疗、重建和康复这些手部，主要目标是尽早获得最大功能。由于这些损伤的性质和复杂性各不相同，此处理流程专门针对个体损伤进行调整。采用了一个技术“重建阶梯”，从“简单”（如直接缝合、植皮、局部皮瓣）到“复杂”（游离皮瓣、拇指再造）。选择的个体手术是最直接的，符合便利性和手部功能早期恢复的原则。组织评估、游离组织移植和熟练的手部治疗方面的最新进展促进了这些手部恢复功能。
