Tsai Yueh-Ju, Carvajal Carolina Forero, Flores Nicolas Moltedo, Lin Tsan-Shiun, Yang Johnson Chia-Shen, Chiang Yuan-Cheng, Lin Pao-Yuan
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
J Int Med Res. 2019 Nov;47(11):5855-5866. doi: 10.1177/0300060519874540. Epub 2019 Sep 26.
This study was performed to share our clinical experience and provide treatment strategies for pediatric hand injuries caused by automatic cup-sealing machines in Taiwan.
Thirteen pediatric patients with an average age of 3.6 years were included in this retrospective study. Treatment was based on the location and depth of the injury and included full-thickness skin grafts, free or local flaps, and digital replantation. Some patients underwent contracture release during follow-up.
Thermal crush injuries affected the left hand in five patients and right hand in eight. Four patients with nine amputated fingers were treated by emergent digital replantation, four were treated by skin grafting, one was treated by nail bed repair, one underwent reconstruction with a local reversed dorsal digital and metacarpal island flap, one underwent reconstruction with a fascia graft for extensor tendon repair and pedicled groin flap coverage, and two underwent reconstruction with free anterolateral thigh fasciocutaneous flaps with a vascularized fascia lata graft for dorsal hand defects. All replanted fingers survived.
Pediatric hand injuries, especially those caused by cup-sealing machines, can be devastating. Aggressive treatments including early reconstruction and rehabilitation should be performed for all pediatric hand injuries to achieve satisfactory functional restoration.
本研究旨在分享我们的临床经验,并为台湾地区儿童因自动封杯机导致的手部损伤提供治疗策略。
本回顾性研究纳入了13例平均年龄为3.6岁的儿科患者。治疗方法根据损伤的部位和深度而定,包括全厚皮片移植、游离或局部皮瓣以及断指再植。部分患者在随访期间接受了挛缩松解术。
热挤压伤累及左手5例,右手8例。4例患者共9根手指离断,接受了急诊断指再植;4例接受了植皮治疗;1例接受了甲床修复;1例采用局部逆行指背和掌骨岛状皮瓣进行重建;1例采用筋膜移植修复伸肌腱,并以带蒂腹股沟皮瓣覆盖;2例采用游离股前外侧筋膜皮瓣加带血管的阔筋膜移植修复手背缺损。所有再植手指均存活。
儿童手部损伤,尤其是由封杯机导致的损伤,可能具有毁灭性。对于所有儿童手部损伤,均应积极进行早期重建和康复治疗,以实现满意的功能恢复。