- 期刊
Cup-sealer Injuries on Pediatric Hands: Clinical Experiences and Literature Review
飲料封口機於小兒手部所造成的嚴重傷害：臨床經驗及文獻回顧
摘要
背景：由於泡沫紅茶在台灣受歡迎，使得飲料封口機也變成做生意的必備工具。當不注意時，尤其年紀很輕的小孩子，會因好奇心而將小手伸入封口機而受到嚴重傷害。關於封口機所造成傷害的機轉及不同程度傷害的臨床處理流程將在此呈現。目的及目標：提供本院過去對封口機所造成的小孩獨特性手部傷害的處理經驗及相關對策。材料及方法：回溯性分析過去在高雄長庚醫院的病歷記載，所有病人均是從現場直接至本院治療，且無其它合併性傷害。治療方法依傷害的部位及深度而決定：淺部灼傷在手指或手背以植皮爲第一選擇，若深部灼傷伴隨著肌腱及骨關節的傷害，則須要局部或游離皮瓣合併肌腱的重建以達到好的功能性回復，若是手指截肢的病患，則須以緊急手術儘可能的以顯微手術重接。結果：從2004至2010年，共有7位病人因封口機產生的接觸性熱傷害，平均年齡爲2.5歲。四位是右手，三位是左手；其中二位病患（共四隻手指）須緊急進行斷指重植手術，一位以手背逆行性皮瓣重建近端指背缺損，一位以腹股溝皮瓣及大腿肌膜重建手指伸肌腱，二位則以游離大腿外側皮瓣及大腿肌膜重建，一位病患只須植皮手術。所有皮瓣及斷指均成功存活，沒有其他相關手術及麻醉併發症。結論：飲料封口機所造成的小兒手部嚴重傷害將會對小朋友的身體印象及與小朋友間的互動有長遠的影響。重建的計劃依受傷的狀況不同，但早期積極的重建，包括顯微手術的使用，及術後復健是這類病人得到良好功能的重點。但最重要的還是要預防小朋友接觸這樣的機器來避免這樣的傷害。
關鍵字
無資料並列摘要
Background:Due to the increasing popularity of ”bubble-tea” as a pastime drink, the use of the automatic cup-sealer machine has become a necessary tool to do business in Taiwan. Unfortunately, having a cup of cold drink sealed and handed to the customer quickly does come with costs when negligence occurs. Children, especially younger ones, can sustain serious injuries to their hands with the cup-sealer machine when unattended. A literatures review and case reports regarding the mechanism of injury and clinical course will be presented.Aim and objectives:To share our clinical results and protocols regarding treatments of unique cup-sealer injuries based on different regions of the hand.Materials and Methods:A retrospective review of medical charts of children injured by the cup-sealer machine and treated at Kaohsiung Chang-Gung Memorial Hospital was conducted. All patients were brought to our hospital for first aid without other associated trauma. Our treatment strategies were based on the location and depth of the injured hand. Full thickness skin graft was the first choice for superficial burns over the dorsal hand or fingers and deep burns with tendon or joint exposure were treated with free or local flaps with tendon reconstruction to obtain the best functional outcome. Digital replantations were performed for all finger amputations.Results:A total of 7 cases occurred between June 2004 and December 2010, which included 6 boys and 1 girl, with an average age of 3 years (range, 1.3 to 9 years). Thermal crush injuries inflicted by cup-sealer machine were located on the right hands of 4 patients and the left hands of 3 patients. Two cases with a total of 4 amputated fingers underwent emergent digital replantation, 1 case was skin grafted, 1 case was reconstructed with local reversed dorsal digital and metacarpal island flap, 1 case received a pedicled groin flap and fascia graft for extensor tendon repair, and 2 cases with dorsal hand defects were reconstructed with free anterolateral thigh fasciocutaneous flaps with fascia lata graft. All flaps survived except for 1 case where partial flap loss was noted in the local reversed dorsal digital and metacarpal island flap. All finger replantations were successful. There were no associated surgical or anaesthesia complication.Conclusion:Pediatric hand injury, especially those caused by a cup-sealer machine, can be devastating to a young child with long-term effects on their body image and social difficulties once they reach school age. Pediatric hand injuries should be treated aggressively in all cases. Early reconstruction and rehabilitation is the mainstay for achieving satisfactory functional restoration. However, prevention is the key for avoiding future incidents.