骨科英文书籍精读（170）｜手外伤（9）
Pulp and finger-tip injuries
In full thickness wounds without bone exposure, the wound should be thoroughly cleaned and then covered with a nonadherent dressing. This is left well alone for 7 days; the accumulation of fluid beneath the dressing is not usually a sign of infection and antibiotics should be avoided. The wound is inspected only infrequently, then re-covered with the non-adherent dressing, until it heals.
If the open area is greater than 1 cm in diameter, healing will be quicker with a split-skin or full thickness graft but the residual pulp cover may not be as satisfactory as a wound that has been left to heal naturally by granulation and re-epithelialization.
If bone is exposed and length of the digit is important for the individual patient, then an advancement flap or neurovascular island flap should be considered. The precise type of flap depends on the orientation of the cut. Otherwise, primary cover can be achieved by shortening the bone and tailoring the skin flaps (‘terminalization’).
In young children, the finger-tips recover extraordinarily well from injury and they should be treated with dressings rather than grafts or terminalization. Thumb length should never be sacrificed lightly and every effort should be made to provide a long, sensate digit.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
nonadherent
non-adherent非粘连的
the accumulation of fluid beneath the dressing is not usually a sign of infection and antibiotics should be avoided.敷料下积液通常不是感染的征兆，应避免使用抗生素.
diameter /daɪˈæmɪtər/n. 直径
epithelialization /'epiθi:liəlai'zeiʃən, -li'z-/n. 上皮形成；外皮形成
advancement flap推进皮瓣
neurovascular island flap神经与血管的岛状皮瓣
tailor /ˈteɪlər/v. 专门制作，订做；调整；迎合n. 裁缝
terminalization 末端化(残端修正)
extraordinarily/ɪkˌstrɔːrdəˈnerəli/adv. 极其，极端地；奇怪地
sensate /ˈsenseɪt; ˈsensɪt/adj. 可感觉的；知觉的
百度翻译：
指腹损伤
对于无骨外露的全厚伤口，应彻底清洁伤口，然后用非粘附性敷料覆盖。这是一个良好的7天，液体的积累下敷料通常不是感染的迹象，应避免使用抗生素。伤口很少检查，然后用不粘的敷料重新覆盖，直到伤口愈合。
如果开放区直径大于1 cm，则裂开的皮肤或全厚皮片的愈合会更快，但残余的牙髓覆盖层可能不如通过肉芽形成和再上皮化自然愈合的伤口那样令人满意。
如果骨头外露，且手指的长度对个别病人很重要，则应考虑采用推进皮瓣或神经血管岛状皮瓣。精确的皮瓣类型取决于切口的方向。否则，可以通过缩短骨骼和裁剪皮瓣来实现初级覆盖。
幼儿的指尖从损伤中恢复得非常好，应该用敷料来治疗，而不是移植或终止治疗。拇指长度不能轻易牺牲，应该尽一切努力提供一个长，感性的手指。