Salehi Seyed Hamid, Fatemi Mohammad Javad, Sedghi Maryam, Niazi Mitra
Department of General Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Plastic and Reconstructive Surgery, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2016 Nov 7;21:109. doi: 10.4103/1735-1995.193501. eCollection 2016.
Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome.
This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients' conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting.
The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant ( = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group ( < 0.0001 and = 0.019).
The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.
尽管对于烧伤手部早期切痂植皮术（EE和G）在降低治疗成本和缩短住院时间方面的影响已达成普遍共识，但关于其对手部功能结局的影响仍存在一些争议问题。本研究旨在比较EE和G以及延迟植皮术在深度手部烧伤中对手部功能结局的影响。
本研究于2012年4月至2013年11月在一家特殊烧伤医院收治的60例手背深度热烧伤且总体表面积（TBSA）<20%的患者中进行。在进行标准的烧伤初期处理和复苏后，根据患者情况进行必要的手术（EE和G或更保守的治疗）。将患者分为早期切痂组（n = 30）和延迟切痂组（n = 30）。在植皮术后6个月，对所有患者测量手指总主动活动度（TAM）、手部握力以及手臂、肩部和手部残疾问卷评估。
EE和G组的平均TBSA百分比高于延迟切痂组（17.34% ± 5.12% 对 15.64% ± 5.83%），但差异无统计学意义（P = 0.23）。6个月后，EE和G组的平均TAM和握力显著高于延迟组（P < 0.0001和P = 0.019）。
本研究表明，EE和G结合适当的物理治疗和康复管理可使手背深度烧伤患者获得更高的功能结局。
