Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA,
Curr Rev Musculoskelet Med. 2014 Mar;7(1):53-9. doi: 10.1007/s12178-013-9192-9.
In addition to burn surgeons, skilled nurses, and therapists, hand surgeons are a key part of the multidisciplinary team caring for patients following thermal injury to the hand. Despite appropriate initial treatment and compressive therapy, contractures are common after deep burn. The most common and functionally limiting are web space and hand contractures. Web space contractures can be managed with excision followed by local soft tissue rearrangement or skin grafting. The classic burn claw hand deformity includes extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstay of management of these postburn contractures includes complete surgical release of scar tissue and replacement by full-thickness skin graft. In cases in which scar contracture release results in major exposure of the tendons or joints, distant tissue transfer is required. This review focuses on prevention and management of late sequelae of thermal injury to the hand focusing on contractures of the webspaces and hand.
除烧伤外科医师、熟练护士和治疗师外，手部外科医师也是手部热损伤患者多学科团队的重要组成部分。尽管进行了适当的初始治疗和加压治疗，但深烧伤后仍常发生挛缩。最常见且功能受限的是蹼状和手部挛缩。蹼状空间挛缩可通过切除，随后局部软组织重新排列或植皮来处理。经典的烧伤爪形手畸形包括掌指关节的伸展挛缩和近节指间关节的屈曲挛缩。这些烧伤后挛缩的主要治疗方法包括彻底松解疤痕组织，并通过全厚皮片移植来替代。在疤痕挛缩松解导致肌腱或关节主要暴露的情况下，需要进行远处组织转移。本篇综述重点关注手部热损伤晚期后遗症的预防和处理，重点关注蹼状和手部的挛缩。
