Résumé
Les amputations des doigts aggravent considérablement le pronostic fonctionnel chez les patients grands brûlés. Dans les lésions unidigitales, c’est l’amputation du pouce qui est la plus invalidante; elle nécessite une reconstruction secondaire, utilisant si nécessaire des techniques sophistiquées de reconstruction microchirurgicale par transfert d’orteil. Les amputations multiples des doigts peuvent être dévastatrices quand le pouce est atteint. Elles posent le maximum de problèmes et nécessitent une stratégie globale de reconstruction privilégiant le rétablissement d’une pince pollicidigitale à deux, voire si possible à trois doigts. Les résultats fonctionnels sont beaucoup plus limités quand les moignons sont courts. La conservation maximale de la longueur digitale doit être une des priorités dans le traitement à la phase aiguë, et justifie les procédés de couverture cutanée par lambeaux chaque fois que possible.
Abstract
Amputation of fingers considerably worsens the functional prognosis in severely burned patients. Among cases where only one digit is involved, amputation of the thumb is the most incapacitating. This requires secondary reconstruction, if necessary with sophisticated microsurgical techniques employing transfer of a toe. Multiple amputations of fingers can be devastating when the thumb is affected. This situation presents a great number of problems and necessitates an overall reconstructive strategy favouring the reestablishment of pinch of the thumb with two or even three fingers. Functional results are much more limited when the stumps are short. The conservation of as much digital length as possible should be one of the priorities during treatment in the acute phase, and this goal justifies operations to obtain cover using skin flaps whenever possible.
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Leclercq, C., Rochet, J.M. Reconstruction des amputations digitales chez le grand brûlé. Lett Med Phys Readapt 27, 107–114 (2011). https://doi.org/10.1007/s11659-011-0276-x
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DOI: https://doi.org/10.1007/s11659-011-0276-x