骨科英文书籍精读（176）｜手外伤（15）
SECONDARY OPERATIONS
The primary treatment of hand injuries should always be carried out with an eye to any future reconstructive procedures that might be necessary. These are of three kinds:
· secondary repair or replacement of damaged structures
· amputation of fingers
· reconstruction of a mutilated hand.
Delayed repair
SKIN
If the skin cover is unsuitable for primary closure or has broken down it is replaced by a graft or flap. As always, the skin creases must be respected. Contractures are dealt with by Z-plasty, skin grafting, or local flaps, regional flaps or free flaps. When important volar surfaces such as the thumb or index tip are insensate, a flap of skin complete with its neurovascular supply may be transposed.
Split thickness skin contracts and so full thickness grafts are preferred. The upper inner arm can provide a fair amount of skin leaving a reasonable cosmetic defect. Larger amounts of skin can be harvested from the groin or abdomen. Bear in mind that grafts will not adhere to raw tendon or bone.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
crease /kriːs/n. 折痕；折缝vt. 弄皱；使起折痕vi. 起皱
Contracture /kənˈtræktʃər/n. [医] 挛缩
Z-plasty Z 字成形术
local flaps, regional flaps局部皮瓣
volar /ˈvoʊlər/ adj. 手掌的，足底的；属于飞行的
insensate /ɪn'sɛnsɪt/adj. 无感觉的；无情的；无生命的
Split thickness skin contracts and so full thickness grafts are preferred. 中厚皮片会发生挛缩，所以全厚皮片移植是首选。
cosmetic/kɑːzˈmetɪk/n. 化妆品；装饰品adj. 美容的；化妆用的
groin /ɡrɔɪn/n. [解剖] 腹股沟；交叉拱vt. 使成穹棱
百度翻译：
辅助操作
手外伤的初级治疗应始终着眼于未来可能需要的重建程序。有三种类型：
·受损结构的二次维修或更换
·手指截肢
·重建残缺的手。
延迟修理
皮肤
如果皮肤覆盖层不适合一期缝合或已损坏，则应更换植皮片或皮瓣。像往常一样，皮肤的皱纹必须得到尊重。对口可采用Z形成形术、植皮术或局部皮瓣、局部皮瓣或游离皮瓣。当重要的掌侧表面，如拇指或食指尖不敏感时，一个带有神经血管供应的皮瓣可以移位。
中厚皮肤收缩，因此全厚皮片是首选。上臂内侧可以提供相当数量的皮肤，留下合理的美容缺陷。从腹股沟或腹部可以收获更多的皮肤。记住移植物不会附着在生肌腱或骨头上。