RU2454185C1 - Method of operative treatment of deep burns of hand - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to plastic surgery, and can be applied in operative treatment of deep burns of hand. Essence of method lies in free transplantation of skin transplants. Early necrectomy of wound on rear surface of hand and fingers is performed. After that, closing of rear surface with thick split grafts is realised, the latter being placed parallel to hand axis with sewing on lateral surface of hand and fingers.

EFFECT: application of claimed invention makes it possible to realise early recovery of hand function after obtained burn, improve remote cosmetic and functional results, eliminate necessity of re-performing reconstructive-restorative surgery after restoration of skin.

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Description

The present invention relates to medicine, in particular to the surgical treatment of deep burns of the hand.

A known method of surgical treatment of deep burns of the hand by closing functionally active surfaces with grafts placed in the transverse direction to the axis of the limb (see V.V. Yudenich. Treatment of burns and their consequences. M: Atlas. 1980, p. 88).

However, the resulting cords between the flaps can limit mobility in the joints and create deformation.

As a prototype, the method of surgical treatment of deep burns of the hand by free transplantation of thin split (0.3 mm) skin grafts onto granulating wounds in the perpendicular direction relative to the axis of the brush was chosen (Vikhriev B.S., Burmistrov V.M. Burns: (Manual for doctors) .- L.: Medicine, 1986. - p. 169).

However, in this case, surgery is performed in a long time, which affects the time of restoration of the function of the brush. Laying thin split transplants on granulating wounds leads to their significant secondary retraction and pronounced cicatricial degeneration. To close extensive wound defects on the hand with the known method, it is necessary to cut out two or even three grafts up to 6 cm wide, which leads to the formation of cicatricial strands between the grafts, reduces not only cosmetic but also functional results and requires additional subsequent reconstructive surgery .

The task of the invention is the early restoration of hand function after a burn, improving long-term cosmetic and functional results, eliminating the need for repeated reconstructive surgery after restoration of the skin.

The problem is solved due to the fact that in a method involving the free transplantation of skin grafts, after performing an early necrectomy, the wounds on the back of the hand and fingers are closed with 10 cm wide split grafts placed parallel to the axis of the hand and stitched on the side surfaces of the hand and fingers.

The method of surgical treatment of deep burns of the hand is as follows. Perform early necrectomy to the bleeding layer and thorough hemostasis using an electrocoagulator. Using a dermatome, a wide (10 cm) split transplant with a thickness of 0.5-0.55 mm corresponding to the length of the wound defect on the back of the hand and fingers is taken from the thigh. Next, the graft is placed on the wound defect of the hand and fingers parallel to the axis of the hand and hem it on the lateral surfaces of the hand and fingers with separate nodal and continuous twisted seams.

Clinical example. Patient M., 30 years old, and.b. No. 191637, was admitted to the burn center of the Institute of Traumatology 04/17/2000 with a diagnosis of a burn with a flame of II-III AB degree of the face, upper and lower extremities on an area of 35% of the body surface, burn shock. On the back surface of the right hand and lower third of the forearm, deep burns were revealed. On April 24, 2000, surgery was performed - early necrectomy and free skin grafting. After removal of non-viable tissues to the bleeding layer, a wound defect of 12 × 28 cm in size was formed on the back of the hand and fingers in the lower third of the forearm. To close the extensive wound defect, a thick split transplant of 0.5 mm was taken from the anterior-lateral surface of the right thigh using an adhesive dermatome 10 × 29 cm in size. The graft is spread on the wounds in a parallel direction with respect to the axis of the forearm and hand. It is fixed to the edges of the wound with separate interrupted and twisted sutures. A moderately pressing aseptic dressing and a plaster cast were applied in the position of flexion in the metacarpophalangeal joints of the 2nd to 5th fingers. The graft has taken root at 98%. The patient was discharged after 1 month with a good functional and cosmetic result.

The method of surgical treatment of deep burns of the hand allows you to restore the function of the hand and fingers in the early stages, prevents the formation of post-burn cicatricial cords between transplants, makes it possible to obtain good long-term functional and cosmetic results, which eliminates the need for repeated reconstructive operations after restoration of the skin.

Claims (1)

A method of surgical treatment of deep burns of the hand by free transplantation of skin grafts, characterized in that after performing an early necrectomy, the wounds on the back of the hand and fingers are closed with thick split grafts located parallel to the axis of the hand and stitched on the side surfaces of the hand and fingers.