Résumé
Les brûlures de la main sont relativement fréquentes en raison de leurs expositions et des accidents de manipulation. Parmi celles-ci, la prise en charge des mains brûlées complexes au stade aigu reste une problématique encore difficile. Après avoir essayé de préciser quelles situations cliniques pouvaient correspondre à la notion de « main complexe », les auteurs passent en revue les possibilités thérapeutiques qui peuvent être utilisées en essayant de dégager des indications: greffes de peau, traitement par pression négative, dermes artificiels et lambeaux. Il apparaît que deux situations doivent être séparées: main brûlée complexe isolée et main brûlée complexe chez un patient grand brûlé. Les difficultés à gérer un patient dans la seconde situation et les options thérapeutiques qui en découlent sont ensuite explicitées. Au final et après étude de la littérature, il apparaît qu’il ne se dégage pas réellement de consensus ou d’algorithme clairement établi.
Abstract
Burns of the hands are relatively common because of their exposure and the risk of accidents occurring during their use. Among these cases, the management of complex burns in the acute stage continues to present a difficult problem. In this article we first define which clinical situations might correspond to the idea of the “complex hand”, and we then review the therapeutic options which are available. We try to clarify the indications for skin grafts, treatment by negative pressure, artificial dermis and skin flaps. It seems that two situations need to be distinguished: the isolated complex burn of the hand and the complex burn of the hand in a patient with third-degree burns. The problems in managing a patient in the latter situation and the therapeutic possibilities that flow from this are then examined. Finally, and after a study of the literature, it appears that there is no real consensus or clearly established protocol.
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Duteille, F., Perrot, P. Prise en charge chirurgicale des mains brulées complexes au stade aigu. Lett Med Phys Readapt 27, 59–63 (2011). https://doi.org/10.1007/s11659-011-0274-z
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DOI: https://doi.org/10.1007/s11659-011-0274-z