The labor organs of the hand are the exposure parts, so there are many chances of injury. Although the area of both hands accounts for only 5%of the body surface area, the structure is fine, and the deformities and dysfunction are often left behind after deep burns. In severe cases, it can lose labor.
Burning can affect the whole hand, but generally more common and heavier with the back of the hand. This is often exposed to the back of the hand, and the skin back skin is thinner. However, if the hand holds the contact burns caused by high -temperature objects directly, it is more common in the palm. The range is generally limited, but the damage is deeper and heavier.
The skin back skin is thin and soft, easy to loosen and elastic; the area of the fist increases by about 25%compared with the stretching; there is less subcutaneous tissue, only a thin layer of loose connective tissue, the skin and the arthrocontoon and joint ligament below the skin and the extensor tendons below The dissecting characteristics of separation make the back depth of the hand of the hands more easily damage the deep tissue, especially the extensor tendon and joint capsule at the interstitial joint of the palm finger and the near -end fingers are easily destroyed, and the scar hyperplasia is often scarred after healing, so that the hands occur severe contracture deformity With dysfunction.
The palm skin is tough and has a thick keratin, with a lot of subcutaneous fat, and is separated by many small connective tissues. Due to these characteristics, the hands are fist -shaped when burn, so the palm burn is generally not deep. However, it is relatively deep when it is in contact. However, due to the large subcutaneous fat and the palm tendon coverage, except for electric burns, there are generally few damage to flexion tendons.
The principle of hand burn treatment is to destroy the wound as soon as possible, reduce the edema of the hand, maintain the function of the hand, prevent infection and restore activities as soon as possible.
The wound as soon as possible is the most basic principle of handling hand burns, and it is also the fundamental measure to maximize the preservation of hand function.
However, there are some common problems in eliminating wounds, such as long -term naked wounds, raising granulation tissue growth, and no skin planting. The long -term exposure of the wound, especially when the tissue of deep burns is not cleared, will inevitably cause infection to deepen the wound. In addition, the long -term existence of the wound limits the early activities of the hand, causing muscle to shrink and the joints are stiff.
So how should we actively prevent this? Should be given priority hand burns. If the whole body is allowed, it should be cut into the wound as soon as possible. Those who fail to cut the scalf in the early days should actively remove the necrotic tissue to plant the skin early, or remove the aging granulation tissue and remove the skin.
If the wounds can be eliminated within 3 weeks, the general functional recovery is better; if the relevant treatment time takes more than 3 weeks, there are so many obvious joint dysfunction.
Secondly, in order to avoid hand dysfunction, edema should be reduced as soon as possible and the edema time should be shortened.
After the edema is mostly, the capillary permeability of the capillaries is increased, the exudation is increased, and the local edema is increased. These exudate liquids are extended, and they are deposited around muscles, joint capsules, and joints. For a long time, it leads to important elastic tissue. The fine tendon sheath fascia, internal muscles, and hard joint capsules are all centered on fibrous tissues. Restrictions, thus joint anchor and dysfunction, severe cases of freezing. Therefore, it is important to reduce the degree of edema and shorten edema.
So, how to control edema as soon as possible? This requires mission to patients, emphasizing the importance of early rehabilitation treatment. It is necessary to inform the patients to move early and raise the affected limb, and keep it in a state of “hand-elbow-shoulders” from high to low, that is, the hand should be higher than the elbow, and the elbow should be higher than the shoulder. The forearm, especially the wrist, if there is a ring -shaped coke and affect the blood circulation of the hand, the coke should be cut and decompressed. But be careful not to emphasize application bandaging to reduce edema. If the bandage is too tight, there is a danger that hinders the cycle, but it is counterproductive and runs counter to the purpose of treatment.
When the hand is injured, no matter what the cause, we must pay attention to keeping the affected limb as the function.
However, it should be noted that the most common hand in hand is the wrist joint flexion, the palm finger joint extension, the joint flexion of the first finger, and the thumbs. Pay attention to the non -functional bit of this hand early. There are different requirements in different cases. The wrist joint should be flexed when the back burns, and the palm burning should be back flexion.
When the back of the hand is burned, the palm finger flexion is 80 ° ~ 90 °, so that the side collateral ligament is maintained at the longest position; The thumb should be kept out of the direction.
Patients with burns are high, and they should pay special attention to prevent infection.
After the wound infection, the deep II degree of the wound surface can be transformed into I degree, and severe cases can damage tendon or complicated arthritis. The key to preventing and controlling infections is to remove necrotic tissues as soon as possible, plant skin in time, and eliminate wounds. It is best to use exposure therapy for depth burns to quickly dry the scorch to reduce the concentration of bacteria and prevent invasion infection. When there are many necrotic tissues, when the infection is serious, such as coke or scoop skin has been self -dissolved or pus under the pus under the pus should be fully drained in time.
As mentioned above, early activities are particularly important to restore their hands as soon as possible.
In addition to the edema tissue after the burns, as the splint restrictions of joint activities, the wound scorching or bandaging therapy also hinders activity. The patients are afraid of pain or worry about the wounds and dare not move. Early activities after hand burn are often restricted. If this situation is not valued and the hand is fixed for a long time, the pathological changes of the deep tissue will lead to all the structures of the edema fiber fibrosis, and the muscle diamond shrinking the tendon adhesion of the joints Sex deformities, loss of function. Therefore, the importance of the activity should be explained to the patient and the early activities should be encouraged.
In order to facilitate activity, expose or semi -exposed therapy is used to encourage patients to take care of themselves, such as eating with spoons, holding fitness ball activities, and twisting towels. In summary, hand burns should not only pay attention to eliminate wounds, restore its integrity, but also pay attention to restoration functions. Early nursing intervention and functional exercises help patients with hand burn to restore their hand function, which is inseparable from the joint collaboration of departments such as burns and rehabilitation departments.
Editor-in-chief of the Ministry of Health of the General Logistics Department of the People’s Liberation Army. Complete Works of Surgery-Plastic Surgery and Burning Surgery Volume. Beijing: People’s Army Medical Publishing House 1996
Li Mengfei, Guo Li, Gu Lipei. Patients with opponent burns performed the effect of standardized care [J]. Contemporary Medicine Cluster, 2021, 19 (4): 166-167. Doi: 10.3969/J.ISSN.2095-7629.2021.04.122.
Wang Xiangnan. Early nursing intervention and functional exercise of opponents’ hand-functional effects of the hand function [J]. China Medical Guide, 2021, 19 (9): 184-185.
Guo Hua, Shu Tian, Qin Ping, waiting for rehabilitation treatment of hand burns [J]. World Composite Medicine, 2015 (3): 238-242. Doi: 10.11966/J.ISSN.2095-994x.2015.01.03.09.
Yue Liqing, Wang Xiaoyan, Peng Huan, et al. Research on rehabilitation of hand burns [J]. Medical clinical research, 2014 (4): 816-819. Doi: 10.3969/J.ISSN.1671-7171.2014.071.
<!-2528: Dermatology terminal page
Fu Jinfeng, Xie Lihua, Liang Ming, etc. The prevention and treatment of functional disorders after hand burns [J]. China Clinical Rehabilitation, 2002, 6 (4): 541. Doi: 10.3321/J.ISSN: 1673-8225.2002.04.046.
Yang Cheng, Wang Yanqiong, Wu Zhihui. Early comprehensive nursing intervention in the prognosis of patients with opponent burns [J]. Chinese beauty medicine, 2020, 29 (10): 167-170.