Palmar scar deformity

Introduction The scar of the palm is a form of deformity after a hand burn. Post-burning deformity refers to a series of deformities that occur after hand burns, including scarring of the back of the hand, hypertrophy of the contracture of the hand, flexion and contracture deformity of the palm of the hand, deformity of the claw-shaped hand, deformity of the ankle, and deformity of the fist.

Cause

Cause: caused by burns in the hands. Scars that are similar in texture to the surrounding skin are called normal scars or mature scars. It accounts for the first place in the deformity of various departments after burns, with a total of about 74%. This is related to the fact that people instinctively cover the face with both hands when the accident occurs, so burns on the back of the hand are more common. The back side of the hand is weaker, so the burns are deeper, often occurring at the same time as the face, or as part of a multi-site or large-area burn. Pathological scars are skin fibrotic diseases that are excessively produced and deposited by a large amount of connective tissue matrix such as collagen.

an examination

Related inspection

CT examination of X-ray lipiodol

diagnosis:

1. Mild: history of hand burns; hypertrophic scars, functional effects are light; under normal circumstances, the inspection project is mainly based on the inspection box "A". When the burn is heavy and the deformity is damaged, the inspection project may include an inspection frame. Limited to "A", "B".

2. Claw-shaped hand deformity: shape deformation, obvious function obstacles; X-ray film confirmed bone and joint deformation.

3. Severely distorted or incomplete deformity: twisted, fist-shaped and crippled. Loss of hand function.

4. Determination of scar hardness, B-type ultrasonic scar thickness measurement, scar surface temperature measurement, transcutaneous oxygen partial pressure measurement, vascular thermal stimulation diastolic index measurement.

Differential diagnosis

Differential diagnosis of palm scar deformity:

1. Unstable scar: refers to the early healing of the wound, and the scar tissue is mostly in the proliferative stage. Clinically, the scar is higher than the leather surface, the color is red, the quality is hard, often itching, the scar tissue is congested, it is easy to blisters, and the wound is getting worse and worse. This process usually takes 6 months to a year.

2, stable scar: refers to the wound healing six months later, the scar tissue gradually matured, the composition of fibroblasts, capillaries gradually decreased, the collagen fibers arranged in a ring-like nodular shape, becoming parallel bundles. At this time, the scar tissue in the clinical area disappeared, the color became lighter, the shape became flatter, the texture became softer, the base became softer, and the itching felt relieved or relieved. This kind of degenerative change can vary from a few months to several years.

3, hypertrophic scar: also known as hypertrophic scar, more common in deep second and shallow third degree burns and thick medium thick skin donor site wound healing. It is thick (up to 1-2 cm) and hard, red or dark purple, painful and itchy, often affecting work and rest. About 6 months later, the scar became softer and slightly flatter, the congestion decreased, the capillaries decreased, and the symptoms of itching gradually diminished or disappeared.

4, atrophic scar: also known as unstable scar, common in the head skull electric shock, after extensive burns and chronic ulcer healing. The scar is hard, the local blood vessels are less, it is reddish or white, the deep tissue is tightly adhered, and it cannot withstand friction and weight. After rupture, it often lasts for a long time, and the late stage can cause malignant changes.

5, keloid: also known as the crab foot swelling, a mass formed by connective tissue. More common in burns, injuries or minor injuries that do not cause the patient's attention. The edge of the scar is significantly higher than the skin, and exceeds the original lesion range, pink or purple, very hard, inelastic, poor blood supply. Keloids are particularly good in the upper part of the body. The head, neck, and sternum are in the middle, shoulders, and upper arms, and the eyelids, areola, and penis are rare.

6, wart scars: scars are wrinkled, shaped like duck plague. Such scars are most common in burns, occasionally in the cutting tears of the skin and improper placement of surgical incisions. Large blemishes often occur in the anterior neck, axillary fossa, elbow fossa and perineum. Small ones are common in internal and external spasm, nasolabial folds, mouth, nostrils, palmar side, finger sputum, tiger's mouth, urethral opening, vaginal opening and other parts.

7, superficial scar: more common in bruises and shallow burns, characterized by a slightly rough appearance, pigmentation changes, local flat and soft, no dysfunction, generally do not need to be treated.

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