Frist W, Ackroyd F, Burke J, Bondoc C
Am J Surg. 1985 Apr;149(4):516-21. doi: 10.1016/s0002-9610(85)80049-0.
Four hundred seventy-eight patients with hand burns (786 hands) were treated at the burn service of the Massachusetts General Hospital. Long-term evaluation showed that early incision and immediate autografting of deep second degree, mixed second and third degree, and third degree full-thickness hand burns resulted in 93 percent, 95 percent, and 93 percent, respectively, excellent to good functional results. There was no significant differences in results in patients with superficial second degree burns treated nonsurgically with silver nitrate dressings and early physical therapy compared with results in patients with deep second degree, mixed second and third degree, and third degree hand burns treated with early excision and grafting. No patient with fourth degree burns had excellent to good results. Permanent damage was related to extent of original injury to the extensor tendons and joint capsules. On the basis of this broad experience, it is believed that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel.
478例手部烧伤患者（共786只手）在麻省总医院烧伤科接受了治疗。长期评估显示，对深二度、二度与三度混合以及三度全层手部烧伤进行早期切开并立即自体植皮，分别有93%、95%和93%的患者获得了优良的功能结果。与采用早期切除和植皮治疗的深二度、二度与三度混合以及三度手部烧伤患者相比，非手术使用硝酸银敷料和早期物理治疗的浅二度烧伤患者的结果没有显著差异。没有四度烧伤患者获得优良结果。永久性损伤与伸肌腱和关节囊的原始损伤程度有关。基于这一广泛经验，人们认为，所有判定在3周内不太可能自愈的烧伤手都将受益于由经验丰富的外科人员进行的早期切除和植皮。
