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应用显微外科技术行游离大网膜移植治疗手骨烧伤国内外已有报道,而双手指骨坏死Ⅰ期完成指再造至今少见报道。近期我科为1例手严重烧伤致十个指骨坏死的患者采用游离大网膜移植加植中厚皮,保留了手指的长度,使双手的外形和功能得到满意的重建。现报告如下。患者女,34岁。因扑救大火、关闭高温阀门致头面部、两下肢及双手烧伤40%,其中Ⅲ度32%伴有吸入性损伤,伤后2小时入院。入院时双手背及手指呈皮革样焦痂,手指缩窄变细。当即行切开减张。3天后见双手拇指末节、其余手指齐掌指关节处均发黑干枯坏死。伤后第6天,患者全身情况稳定后,即在全麻下行双手背及手指切痂,见两手拇指末节发黑无血运,其余双手各指干细、血管栓塞、肌腱及指骨呈褐色,予以保留。遂决定采用游离大网膜移植以避免截指。取上腹正中切口进腹提出大网膜,其血管分布为Ⅰ型。适当裁剪,形成以左、右网膜血管为蒂,长宽为30cm×15cm 大小的二个网膜瓣。取下网膜瓣
Application of microsurgery free omentum transplantation in the treatment of hand bone burns have been reported at home and abroad, while the phalanx of the phalanx finish stage Ⅰ refers to the rebuild of rare reports so far. Recently, our department was a case of severe pharyngitis caused by ten hand pharyngitis necrosis patients with free omentum transplantation and planting thick skin, retaining the length of the fingers so that the shape and function of both hands were satisfactorily reconstructed. The report is as follows. Female patient, 34 years old. Due to fighting the fire, close the high temperature valve caused the head and face, two lower limbs and hands burns 40%, of which 32% with grade Ⅲ with inhalation injury, 2 hours after admission. On admission, both hands and fingers were leather-like eschar, finger narrowing and thinning. Immediately cut open cuts. 3 days after the thumb see the hands of both hands, the other fingers are metacarpophalangeal joints were black dead necrosis. The first 6 days after injury, the patient’s condition was stable, that is, under both general anesthesia back and fingers escharectomy, see both hands thumb black blood-no blood movement, the remaining hands fingers thin, blood vessels embolism, tendon and phalanx were brown, Be retained. Then decided to use the free omentum transplantation to avoid interception. Take the median abdominal incision into the omentum proposed omentum, the vascular distribution of type Ⅰ. Appropriate cutting, the formation of the left and right retinal vascular pedicle, length and width of 30cm × 15cm size of the two retinal flap. Remove the flap