应用整形外科技术Ⅰ期分区修复急诊面部外伤的治疗体会  

Experience of using plastic surgery technique to regionally repair facial trauma in stage Ⅰ

作　　者：张娟 裴蛟淼 魏思明 权鑫 宋保强 雷磊 Zhang Juan;Pei Jiaomiao;Wei Siming;Quan Xin;Song Baoqiang;Lei Lei(Department of Plastic Surgery,First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China;Department of Emergency Medicine,First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院整形外科,西安710032 [2]空军军医大学第一附属医院急诊科,西安710032

出　　处：《中华损伤与修复杂志（电子版）》2021年第5期427-431,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：陕西省2020年重点研发计划(2020SF-179)。

摘　　要：目的总结应用整形外科外科技术I期分区修复面部外伤的相关临床经验。方法回顾性分析2016年9月至2020年2月期间空军军医大学第一附属医院整形外科收治的17例面部外伤患者的临床资料,内容包括患者性别、年龄、受伤原因、伤口累及部位,评估患者病情后在局部麻醉或全身麻醉下,彻底清创后采用直接逐层对位缝合、原位回植及反取回植等手术方法修复创面,术后予以相关对症支持治疗,预防并发症的发生。术后1年面诊随访,评估患者瘢痕增生情况、有无明显畸形及填写患者满意度调查表。结果所有患者均I期修复,患者满意度为88.2%。16例患者伤口甲级愈合,无感染、血肿、皮瓣坏死等不良反应发生。1例鼻部完全撕脱伤患者出现局部皮瓣坏死,经换药后痊愈。后期随访14例患者瘢痕细小或不明显,无明显畸形。1例患者出现上睑退缩。1例出现右侧鼻翼部分缺损。结论面部外伤的伤情复杂,累及颜面部多个分区。早期稳定生命体征后根据损伤的复杂性和可能涉及的重要结构,修复时遵循整形外科由易到难、分区修复的原则,可以取得满意的修复效果。Objective To summarize the clinical experience of using plastic surgical technique regional repair of facial trauma in stageⅠ.Methods Clinical data of 17 patients with facial trauma admitted to Department of Plastic Surgery,First Affiliated Hospital of Air Force Military Medical University from September 2016 to February 2020 were retrospectively analyzed,including gender,age,injury cause and wound involvement site.After the evaluation of the patient′s condition,surgical methods such as direct layer to layer suturing,in situ replantation and reverse graft replantation were used to repair the wound after thorough debridement under local or general anesthesia.And relevent symptomatic support was given after the operation to prevent the occurrence of complications.One year after operation,the patients were followed up by face-to-face consultation to evaluate the hyperplasia of scar,the presence of obvious deformity and fill in the patient satisfaction questionnaire.Results All patients were repaired in stage I.The patient satisfaction was 88.2%.Wound healing was performed in 16 patients without infection,hematoma,skin flap necrosis and other adverse reactions.Local skin flap necrosis occurred in one patient with complete avulsion of the nose and recovered after dressing change.In the late follow-up,14 patients had small or inconspicuous scar and no obvious deformity.One patient presented with upper eyelid shrinkage.Partial defect of right alar nose occurred in 1 case.Conclusion Facial trauma is complex and involves multiple facial regions.After early stabilization of vital signs,according to the complexity of the injury and the important structures involved,satisfactory repair results can be obtained by following the principle of repair from easy to difficult and regional repair in the department of plastic surgery.

关 键 词：面部损伤 外科 整形 伤口愈合 分区修复 

分 类 号：R622[医药卫生—整形外科]