面颈部皮肤撕脱伤整形修复效果探讨(1)
[摘要]目的：探讨采用整形原则修复面颈部皮肤撕脱伤，提高撕脱组织存活率、减少术后瘢痕的效果。方法；2017年6月-2017年9月笔者医院收治面颈部皮肤撕脱伤患者17例，共19处损伤。在急诊根据撕脱皮瓣损伤程度进行相应处理：撕脱皮瓣面积相对较小、组织无明显碾挫伤者，清创后行撕脱皮瓣原位缝合；撕脱皮瓣末端血供障碍者，将其远端修成真皮下血管网皮瓣或全厚皮片原位回植，予以打包包扎，并应用美容缝合技术。结果：18处皮瓣术后成活良好，仅1处皮瓣发生小面积坏死，经换药后愈合，术后瘢痕不明显，外形满意，功能恢复良好。结论：对于面颈部皮肤撕脱伤，急诊外伤处理过程中恰当地运用整形美容外科原则及技术，可使局部创伤在最大限度上获得功能及美学修复，值得临床推广。
[关键词]皮肤撕脱伤；面颈部；打包包扎；存活率；瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0011-03
, 百拇医药
Abstract： Objective To explore the effect of using principle of plastic surgery to repair the face and neck avulsion skin in order to increase the survival rate of avulsed tissue and reduce scar. Methods 17 cases of avulsion injury of the face and neck were treated in our hospital from June 2017 to September 2017， there were 19 injuries. According to the degree of injury， we adopted different treatment strategies： If the flap was small and the tissue was not obviously crushed， we sutured the flap in situ. If the blood supply of the avulsion flap is poor， we would trim it into a flap with subdermal vascular network or full-thickness skin， then replant it in situ with moderate pressure dressing and apply the technique of cosmetic suture. Results 19 wounds survived after using appropriate surgical procedure according to the principle of plastic surgery. Postoperatively， only small area of the a avulsion skin occurred necrosis， but after dressing and healing after skin grafting， there was no obvious scar appearance. The patients were satisfied with the good functional recovery and wound reparation. Conclusion Suitable disposal to the face and neck avulsion skin applying the cosmetic surgery technique and principle can obtain maximatily functional and aesthetic recovery. It is worthy for clinical promotion.
, http://www.100md.com
Key words： skin avulsion injury； face and neck； packing and bandaging； survival rate； scar
由于车祸及机械性外伤数量渐增，面颈部皮肤撕脱伤已成为急诊外科的一种常见病。虽然对生命的威胁不如重要脏器伤那样严重和直接，但对容貌的影响及由此造成的心理障碍，远胜于身体其他部位[1]。因此，对面颈部皮肤撕脱伤及创面的处理尤为重要。2017年6月-2017年9月，笔者医院急诊外科共手术治疗面颈部皮肤撕脱伤患者17例。根据撕脱皮瓣损伤程度进行相应处理：对于撕脱皮瓣面积相对较小、组织无明显碾挫伤者，采用撕脱皮瓣原位缝合、梯度打包包扎术；对于撕脱皮瓣末端血运障碍者，将其远端修剪成真皮下血管网皮瓣或全厚皮片原位回植[2]，予以打包包扎的整形修复方法治疗[3]，并应用美容缝合技术，取得了满意效果，现报道如下。
1 临床资料
, http://www.100md.com
本组共17例患者，19处皮瓣撕脱损伤。年龄2.5～41.0岁，平均(12.5±2.0)岁；男13例，女4例；撕脱皮瓣大小为0.4cm×2.0cm～1.5cm×3.5cm；受伤入院时间0.5～10h；损伤原因：跌倒致伤8例，交通伤4例，锐器伤5例；受伤部位：额部5例，鼻背2例，上下睑3例，颊部4例，颏部3例，颈部2例；损伤情况：除锐器伤外，其余撕脱皮瓣创缘不齐伴有不同程度碾挫；撕脱皮瓣深度：2例额部撕脱皮瓣深及额骨表面，3例上睑撕脱皮瓣深及眼轮匝肌层伴有部分眼轮匝肌撕裂，其余14例深及淺筋膜层。
2 治疗方法
2.1 术前检查及处理：询问病史明确诊断，了解致伤因素、受伤时间，对患者基本情况进行评估，排除眼球损伤、骨折、颅脑损伤等严重复合伤，对患者面颈部外伤情况的手术修复方法作出判断，制定初步治疗方案。, 百拇医药(崔江波 裴蛟淼 姚文德)
[关键词]皮肤撕脱伤；面颈部；打包包扎；存活率；瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0011-03
, 百拇医药
Abstract： Objective To explore the effect of using principle of plastic surgery to repair the face and neck avulsion skin in order to increase the survival rate of avulsed tissue and reduce scar. Methods 17 cases of avulsion injury of the face and neck were treated in our hospital from June 2017 to September 2017， there were 19 injuries. According to the degree of injury， we adopted different treatment strategies： If the flap was small and the tissue was not obviously crushed， we sutured the flap in situ. If the blood supply of the avulsion flap is poor， we would trim it into a flap with subdermal vascular network or full-thickness skin， then replant it in situ with moderate pressure dressing and apply the technique of cosmetic suture. Results 19 wounds survived after using appropriate surgical procedure according to the principle of plastic surgery. Postoperatively， only small area of the a avulsion skin occurred necrosis， but after dressing and healing after skin grafting， there was no obvious scar appearance. The patients were satisfied with the good functional recovery and wound reparation. Conclusion Suitable disposal to the face and neck avulsion skin applying the cosmetic surgery technique and principle can obtain maximatily functional and aesthetic recovery. It is worthy for clinical promotion.
, http://www.100md.com
Key words： skin avulsion injury； face and neck； packing and bandaging； survival rate； scar
由于车祸及机械性外伤数量渐增，面颈部皮肤撕脱伤已成为急诊外科的一种常见病。虽然对生命的威胁不如重要脏器伤那样严重和直接，但对容貌的影响及由此造成的心理障碍，远胜于身体其他部位[1]。因此，对面颈部皮肤撕脱伤及创面的处理尤为重要。2017年6月-2017年9月，笔者医院急诊外科共手术治疗面颈部皮肤撕脱伤患者17例。根据撕脱皮瓣损伤程度进行相应处理：对于撕脱皮瓣面积相对较小、组织无明显碾挫伤者，采用撕脱皮瓣原位缝合、梯度打包包扎术；对于撕脱皮瓣末端血运障碍者，将其远端修剪成真皮下血管网皮瓣或全厚皮片原位回植[2]，予以打包包扎的整形修复方法治疗[3]，并应用美容缝合技术，取得了满意效果，现报道如下。
1 临床资料
, http://www.100md.com
本组共17例患者，19处皮瓣撕脱损伤。年龄2.5～41.0岁，平均(12.5±2.0)岁；男13例，女4例；撕脱皮瓣大小为0.4cm×2.0cm～1.5cm×3.5cm；受伤入院时间0.5～10h；损伤原因：跌倒致伤8例，交通伤4例，锐器伤5例；受伤部位：额部5例，鼻背2例，上下睑3例，颊部4例，颏部3例，颈部2例；损伤情况：除锐器伤外，其余撕脱皮瓣创缘不齐伴有不同程度碾挫；撕脱皮瓣深度：2例额部撕脱皮瓣深及额骨表面，3例上睑撕脱皮瓣深及眼轮匝肌层伴有部分眼轮匝肌撕裂，其余14例深及淺筋膜层。
2 治疗方法
2.1 术前检查及处理：询问病史明确诊断，了解致伤因素、受伤时间，对患者基本情况进行评估，排除眼球损伤、骨折、颅脑损伤等严重复合伤，对患者面颈部外伤情况的手术修复方法作出判断，制定初步治疗方案。, 百拇医药(崔江波 裴蛟淼 姚文德)