下颌缘双蒂皮瓣联合创缘几何形破裂线设计一期修复面颊部严重犬咬伤  

APPLICATION OF DOUBLE PEDICLED FLAP AND TECHNIQUE OF GEOMETRIC BROKEN LINE FOR PRIMARY REPAIR OF SERIOUS DOG BITE WOUNDS

作　　者：余道江[1] 赵天兰[1] Anne MORICE 伍丽君[1] 孙卫[1] 于文渊[1] 李秀洁[1] 王帅[1] 王睿[1] 

机构地区：[1]苏州大学附属第二医院整形外科,江苏苏州215004 [2]巴黎Necker儿童医院整形外科

出　　处：《中国修复重建外科杂志》2016年第8期926-929,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：江苏省临床治疗技术研究与示范应用项目(BL 2014041);苏州市科技指导计划项目(SYSD 2013095;SYSD 2015092)~~

摘　　要：目的探讨下颌缘双蒂皮瓣联合创缘几何形破裂线(geometric broken line,GBL)设计一期修复面颊部严重犬咬伤的疗效。方法 2006年10月-2014年12月,收治9例面颊部严重犬咬伤患者。男3例,女6例;年龄8~68岁,平均34.5岁。伤后至入院时间30 min^24 h,平均4 h。创面缺损范围1.7 cm×0.5 cm^15.0 cm×8.0 cm;深度达0.3~0.8 cm,平均0.5 cm;合并深部组织外露。入院后彻底清创、持续封闭式负压引流(vacuum sealing drainage,VSD)及灌洗1 d后行创面修复。术中修剪面颊缺损内上方创缘,设计成以矩形和直角为主的GBL,并在缺损外下方设计与之对应的创缘GBL;然后在缺损外下方设计并切取大小为1.7 cm×1.5 cm^18.0 cm×15.0 cm的双蒂皮瓣修复创面。供区直接拉拢缝合。术后继续VSD治疗3 d。结果术后患者皮瓣均顺利成活,创面Ⅰ期愈合。供区切口Ⅰ期愈合,瘢痕隐蔽。患者均获随访,随访时间6个月~8年,平均4年。患者面部外形满意,未遗留明显瘢痕。随访期间无狂犬病发作。结论下颌缘双蒂皮瓣联合创缘GBL设计可一期修复面部严重犬咬伤,获得满意美容效果。Objective To evaluate the effectiveness of double pedicled flap and technique of geometric broken line（GBL） for primary repair of serious dog bite wound. Methods Between October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34. 5 years（range, 8- 68 years）, and with a mean disease duration of 4 hours（range, 30 minutes to 24 hours）. The defect ranged from 1. 7 cm× 0. 5 cm to 15. 0 cm× 8. 0 cm, with the mean depth of 0. 5 cm（range, 0. 3- 0. 8 cm）. Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage（VSD） was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1. 7 cm× 1. 5 cm to 18. 0 cm× 15. 0 cm. The donor site was sutured directly. VSD was used for 3 days after operation. Results All flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years（mean, 4 years）. The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up. Conclusion It is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.

关 键 词：双蒂皮瓣 几何形破裂线 面部 犬咬伤 

分 类 号：R782[医药卫生—口腔医学]