Barbasse L, Serror K, Boccara D, Mimoun M, Benyamina M, Chaouat M
Hopital Saint Louis, Paris, France.
Ann Burns Fire Disasters. 2022 Mar 31;35(1):68-73.
Hands are one of the most often burnt parts of the body. Deep palmar burns are often the result of an electrical burn or a thermal burn from grasping a hot item. With a deep burn, joints, vasculo-nervous pedicles, tendons or bones can become exposed and lead to amputation. Different surgical repair methods are used depending on the area of the hand that is burnt. Most of the publications to date have described surgical techniques for dorsal hand burns. The abdominal bag-shaped flap is one of the main surgical techniques to cover dorsal deep tissue exposure. Bag-shaped flaps need time to achieve the vascular autonomy of the flap without any movement. Abdominal bagshaped flaps are particularly suitable for dorsal soft-tissue defects, while for palmar defects, it is an uncomfortable position to maintain for three weeks. A contralateral arm bag-shaped flap for palmar burns allows a comfortable position to be achieved as the upper burnt limb is positioned as if the patient has their arms crossed. Furthermore, as stated above, the contralateral arm bag-shaped flap has the advantage of allowing a flap to be used that is thinner than an abdominal bag-shaped flap. At the Saint Louis Burns Center, we recently treated two patients with deep palmar burns and deep tissue exposure. We performed a contralateral arm bag-shaped flap for both of these patients. In our experience, the use of the contralateral arm bag-shaped flap technique to cover palmar lesions resulted in favorable postoperative progression, with complete closure of the lesions, good functional outcomes, as well as other advantages such as a hidden scar at the donor site. This technique allows amputation of fingers to be avoided when pedicles, joints, or tendons are exposed and when the burnt area of the palm is extensive and no other flaps can be used.
手部是身体最常被烧伤的部位之一。手掌深部烧伤通常是触电烧伤或因抓取热物品导致的热烧伤所致。深度烧伤时，关节、血管神经蒂、肌腱或骨骼可能外露，进而导致截肢。根据手部烧伤的部位不同，会采用不同的手术修复方法。迄今为止，大多数出版物都描述了手背烧伤的手术技术。腹部袋状皮瓣是覆盖手背深部组织外露的主要手术技术之一。袋状皮瓣需要时间来实现皮瓣的血管自主且无需任何移动。腹部袋状皮瓣特别适用于手背软组织缺损，而对于手掌缺损，保持三周的这种体位会很不舒服。用于手掌烧伤的对侧上臂袋状皮瓣能实现舒适的体位，因为烧伤的上肢处于如同患者双臂交叉的位置。此外，如上所述，对侧上臂袋状皮瓣的优点是可以使用比腹部袋状皮瓣更薄的皮瓣。在圣路易斯烧伤中心，我们最近治疗了两名手掌深部烧伤且深部组织外露的患者。我们对这两名患者都实施了对侧上臂袋状皮瓣手术。根据我们的经验，使用对侧上臂袋状皮瓣技术覆盖手掌创面术后恢复良好，创面完全闭合，功能效果良好，还有其他优点，比如供区瘢痕隐蔽。当血管蒂、关节或肌腱外露且手掌烧伤面积广泛且无法使用其他皮瓣时，这种技术可避免手指截肢。
