Wang Fei, Liu Sheng, Qiu Le, Ma Ben, Wang Jian, Wang Yong-Jie, Peszel April, Chen Xu-Lin
From the Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China.
Ann Plast Surg. 2015 Dec;75(6):603-6. doi: 10.1097/SAP.0000000000000602.
Severe burn and infection to hands always involves the deep structures, such as tendons, joints, and bones. These wounds cannot be closed immediately and therefore creates a high risk for complication. We presented 9 cases with deep dermal burns to the dorsal of the hand (6 electrical burns and 3 thermal crush injuries) with wound infections in 2 cases. The vacuum-assisted closure system was used continuously until the flap reconstruction was performed. A random pattern and superthin abdominal wall skin flap-like glove was designed. The flap was transferred to the defected portion of the dorsum of the hand and resected from the abdominal wall about 3 weeks later. The flaps in 8 of the patients treated by this technique survived completely and partial necrosis of the distal flap occurred in 1 patient. The defect resolved after operative treatment and the function of the hands and fingers were successfully salvaged. All patients resulted in having a satisfactory aesthetic outcome with no or minor discomfort at the abdominal donor area. Integration of the vacuum-assisted closure system and the superthin abdominal wall glove-like flap reconstruction appeared to be successful and should be considered in patients with severely burned hands.
手部的严重烧伤和感染总是累及深部结构，如肌腱、关节和骨骼。这些伤口无法立即闭合，因此产生了较高的并发症风险。我们报告了9例手部背部深度真皮烧伤（6例电烧伤和3例热挤压伤），其中2例发生伤口感染。持续使用负压封闭引流系统，直到进行皮瓣重建。设计了一种随意型超薄腹壁皮瓣样手套。将皮瓣转移到手背缺损部位，约3周后从腹壁切除。采用该技术治疗的8例患者皮瓣完全存活，1例患者远端皮瓣发生部分坏死。经手术治疗后缺损得到解决，手部和手指的功能得以成功挽救。所有患者均获得满意的美学效果，腹部供区无不适或仅有轻微不适。负压封闭引流系统与超薄腹壁手套样皮瓣重建相结合似乎是成功的，对于手部严重烧伤的患者应予以考虑。
