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題 名 | Management of Third Degree Scalding Burn Injury in an 89-Year-Old Lady Associated with Comorbidities=一位三度燒傷八十九歲女性有多重合併症之治療 |
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作 者 | 李存昌; 陳奕安; 張瓊文; 李嘉琳; 陳杰峰; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 26:1 2017.03[民106.03] |
頁 次 | 頁132-138 |
分類號 | 416.141 |
關鍵詞 | 老年燒傷; 縮短手術時間; 早期清創和植皮; Elderly burn; Low risk anesthesia; Short duration surgery; Tumescent procedure; Early excision and graft; |
語 文 | 英文(English) |
中文摘要 | 背景:隨著高齡化社會來臨,在台灣老年人的數目越來越多。而治療深度燒傷的老年人,一向是充滿挑戰,過往高齡深度燒傷合併感染的病患有很高的死亡率,要注意許多細節和必需付出心力的工作。目的:提供一位合併多重合併症老年人燒傷個案的成功疾病治療過程。方法:一位八十九歲的女性因熱水燙傷造成她左上臂、腋下、背部多處燒傷。因為年老及失能偏癱,燒傷發生時無法自行移動身體,以至於就醫時發現都是三度燒傷,佔體表面積百分之七。她本身有多重合併症,包含糖尿病、高血壓、慢性阻塞性肺病、慢性心臟衰竭、冠心症及腦中風合併左側偏癱。選擇千分之六英吋厚度的取皮,經過兩階段植皮及多面向不同團隊的合作幫忙,病患植皮皆成功,並在燒傷後第十八天順利出院。結果:利用早期創植皮及縮短的手術時間治療一位八十九歲的女性病患,成功地挽救了她的生命。出院後,我們提供一個為期一年完整多團隊的醫療照顧系統,除了疾病的治療外,更多元的支持。病患在一年後的追蹤中,取皮和植皮區除了色素沉積外,都很柔軟。結論:多重合併症老年人燒傷的治療和復健需要多團隊的支持。利用分次短時間的早期清創和植皮手術,可以減少手術時間和出血,達到成功治癒老年燒傷的目標。 |
英文摘要 | Background: In Taiwan, the number of elderly patient is increasing. It is a high challenge work and need all efforts to treat elderly patient with deep burns. Aim and Objectives: In spite of high mortality in aged deep burn patient with severe wound infection, we did early debridement and skin graft at a short term operating time for an 89 year-old lady, a strategy was described and successfully save her live. Material and Method: An 89 year-old lady suffered from 7 % BSA deep scalding burn over left arm, axillary and back region by boiling water. She had multiple comorbidities. Two stages operation of skin graft was performed with tumescent anesthesia. Result: After two stages operation of skin graft by efforts of multidisciplinary cohort, she was discharged on PBD 18 with all graft skin were taking well. After discharged from hospital, we create holistic medicine care system in our outpatient department for one year, her donor and recipient wounds showed soft scar with pigmentation. Conclusion: Early and staged debridement and ultra-thin skin grafting combined with tumescent anesthesia make the operation safer with short operation time, especially in the elderly patient with multiple comorbidities. |
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