Eleven patients with roller injuries to the upper extremity are described. Nine were treated initially; two were referred for treatment within 3 weeks after injury. Six patients were injured by kneading machines in bakeries, two by hot dry-cleaning mangles, two by industrial rolling machines, and one by a transmission belt which acted as a roller. The tissue damage depends on (1) the space between the rollers, (2) the speed of the rollers, (3) the hardness of the rollers, (4) the temperature of the rollers, and (5) how violently the patient attempts to withdraw the entrapped part. Lesions may be closed, consisting of a compression of the soft tissues, which may result in skin necrosis, or a tearing and separation of the skin and soft tissues away from the deep fascia (more common on the dorsal surface of the hand), or destruction of skin and deep tissue because of burns. Closed injuries usually respond to conservative care, although decompression sometimes is necessary. Experience gained from treating these 11 patients indicates that the inexperienced surgeon often tries to replace distally based flaps. Such flaps usually die and predispose to deep infection. If the condition of the wound permits, primary skin grafts should be applied; but if the bed is of poor quality, skin grafting can be delayed for several days. If it is necessary to protect exposed deep structures, they should be covered with immediate pedicle flaps. It is better to use skin from an uninjured area for a free skin graft than to use the avulsed skin as a graft. Distant flaps should be used if secondary reconstruction is anticipated. In circumferential skin loss, a combination of pedicle skin and free skin grafts is better than encircling the part with a pedicle flap. The thumb and radial fingers should be preserved, but the ulnar fingers are expendible in severe injuries. By amputating parts of fingers, reconstruction often is simplified.

译文

描述了11例上肢滚子受伤的患者。最初治疗了9个; 受伤后3周内转诊了2个。六名患者在面包店被捏合机伤害,两名被热干洗杂物伤害,两名被工业轧制机伤害,一名被用作滚筒的传动带伤害。组织损伤取决于 (1) 辊之间的空间,(2) 辊的速度,(3) 辊的硬度,(4) 辊的温度,以及 (5) 患者尝试如何剧烈地抽出夹带的部分。病变可能是闭合的,包括软组织的压迫,这可能导致皮肤坏死,或皮肤和软组织远离深筋膜撕裂和分离 (更常见于手背表面),或由于烧伤而破坏皮肤和深层组织。闭合性损伤通常对保守护理有反应,尽管有时减压是必要的。从治疗这11名患者中获得的经验表明,经验不足的外科医生经常尝试更换远端皮瓣。这种皮瓣通常会死亡并容易感染。如果伤口条件允许,应进行初次皮肤移植; 但是如果床质量差,则植皮可以延迟几天。如果有必要保护裸露的深层结构,则应立即用椎弓根皮瓣覆盖。使用未受伤区域的皮肤进行游离皮肤移植比使用撕脱的皮肤作为移植更好。如果预计二次重建,应使用远处皮瓣。在周向皮肤丢失中,椎弓根皮肤和游离皮肤移植物的组合比用椎弓根皮瓣包围该部分更好。应保留拇指和radial骨手指,但在严重受伤时尺骨手指可扩展。通过截肢手指的一部分,重建通常被简化。

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