日本職業・災害医学会会誌第54巻第6号

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2 274 日本職業災害医学会会誌 JJOMT Vol. 54, No. 6 図 1 初診時所見上左足は足背の全体と踵部以外の足底が III 度熱傷であった下右足は足底の踵部から足背外踝部にかけて III 度熱傷でありそれ以外は深達性 II 度熱傷であった図 2 受傷後 19 日目に左足の III 度熱傷のデブリードメンと第 1 趾の壊死した末節骨第 2 5 趾の中節骨 1/2 より末梢の切除を行った足背部には分層植皮足底には全層植皮を行った図 3 右足は受傷後 35 日目に肉芽創に対し足背に分層植皮足底に全層植皮を行った図 4 右足初回手術 6 カ月後の 1 歳 4 カ月時に第 4 5 趾の背屈拘縮に対して形成術と全層植皮を行った皮を行った図 3 植皮の生着は両足とも良好であったため受傷後 2 カ月で退院となったらの全層植皮足背部には右大腿部からの 11/1,000 イン長期経過退院時は生後 11 カ月であったがつかまチの厚さの分層植皮を行った右足に関しては足底のり立ちが可能であった外来にて経過を観察していたが深達性 II 度熱傷部の上皮化をさらに期待し軟膏治療を継退院後 3 カ月頃より右足第 4 5 趾の背屈が著明になり続した受傷後 35 日右足の足底踵部から外側踝部に右足初回手術後 6 カ月の 1 歳 4 カ月時に拘縮除去と右鼠かけての肉芽創に対し足底には左鼠径部からの全層植径部からの全層植皮を行った図 4 皮外踝周囲は左大腿部からの 8/1,000 インチの分層植歩行の発達は生後 1 歳 6 カ月から自立歩行が可能とな

5 Reprint request: A CASE REPORT OF LONG-TERM TREATMENT FOR A CHILD WITH SEVERE BURNS ON FEET Akira SUGAMATA 1) and Hajime MATUMURA 2) 1) Department of Plastic Surgery, Tokyo Medical University Hachiouji Medical Center 2) Department of Plastic Surgery, Tokyo Medical University Pediatric severe foot burns including the sole have significant characteristics. But few papers on the problems of foot burns can be found in medical literature. When improper primary treatments are administered to these burns, frequent post burn complications will torment the patients. We treated one pediatric case with severe foot burn of the both feet, and evaluated the case over 21 years from follow-up results. The patient was a 9-months old boy with bilateral feet burns including the dorsal sides and soles. The burns were intermingled with deep dermal burns and deep burns. After 19 days of conservative treatment, we conducted full-thickness skin grafts to the deep burns of the right sole from the inguinal region and split-thickness skin grafts to the deep burns of the dorsal sides from the thigh region. On 35 post-injured days, we performed the same operation method to the left foot. Both non-weight bearing areas of the soles were epithelialized using conservative treatment. In the follow-up period, we needed additional skin grafts to the both dorsal sides of the feet because of remarkable skin contractures. But full thickness skins grafted to the soles did not indicate any major problems with only slight hyperkeratosis in the right heel. During the patient s adolescent period, we performed exchanging grafts to the both soles from the non-weight bearing areas to prevent skin complications caused by increasing body weight and moving activity. To keep specific characteristics of the plantar skin, we should treat pediatric foot burns for more than 3 weeks with conservative treatment in the primary stage. Burns that do not heal within 3 weeks are best managed with a full-thickness skin graft from the inguinal region.

2 10 The Bulletin of Meiji University of Integrative Medicine 1,2 II 1 Web PubMed elbow pain baseball elbow little leaguer s elbow acupun

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