面部脱套伤

Facialdeglovinginjury面部脱套伤Reportedbylifesaver汇报人：生命医号Deglovinginjury•Definition:deglovingisskinandsubcutaneoustissuedetachment,mostoftenaffectingthelimbsandextremitiesandoccasionallythescalp•Stemingfrom:high-energytrauma,trafficorindustrialaccidents,butalsobeintentional,suchasdeglovingapproachinoralmaxillofacialsurgerySomecasesaboutfacialdeglovinginjury部分图片可能引起不适，建议请勿在进食时观看，胆小勿看。Case1•A30-year-oldwhitewomanwasthevictimofseverefacialtraumastemmingfromarolloverautomobileaccident。•9hafteraccident,thepatientwasconscious(有意识的),oriented(定向的),pale(苍白的),tachypneic(呼吸急促的),tachycardic(心博过速的)Fig.1.(A)Frontalviewofthepatientwithfacialflapdownshowingcommunicationbetweenthenasalandoralcavitiesafterseveretrauma;(B,C)rightandleftprofilesofthepatient.Notethatthewholemouthandalargefragmentofjawwerekeptinplaceonlybythesofttissueofthebuccalvestibule.Treatment•Undergeneralanaesthesiathroughthetracheostomy（气管造口术，气切）•Explorationandrigoroussurgicalcleaningoftheextensivefacialwoundandhemostasis(止血)oftheinjuredvesselswereperformed•Bloodvolumereestablishedwith2000mloflactatedRinger’ssolutionandtworedbloodcellconcentratesPrimarysurgery•Reconstructthenasalstructurestoallowpermeabilityoftheupperairways,•Repositiontheextrinsicmusculatureoftheorbits•RepositionthemaxillathroughmaxillomandibularfixationwithEricharchbarsforthemaintenanceofthedentalarches.•Theonlybonefracturestreatedwerethosethatwereexposedbythetrauma:anteriorwallofthefrontalsinus,leftzygomaticarchandnasalbones(A,B)Thepatientaftercopiouswashingofthewoundwithsaline,removalofdevitalizedtissueandfixationoffracturesofthefrontalbonesandnasalandleftzygomaticarcheswithtitaniumminiplates;(C)repositioningofthemaxilla;(D)theimmediatepostoperativeperiod•Theinitialsurgicalprocedurelasted6h•Thepatientwassenttothepost-anaesthesiacareunit.•shewasconsciousandhemodynamically(血液动力学)stable,didnotrequiremechanicalventilation.•Takingvenousantibioticsandpainkillers,inadditiontoenoxaparin(依诺肝素)prophylaxisforvenousthrombosis.(静脉抗炎、止痛、抗凝)(A)Imagesafterthefirstsurgicalprocedure(10days),showingtelecanthusandptosisoftheupperrighteyelid(B)(B,C)satisfactoryocclusionandabsenceofnecrosisofthejawSecondsurgicalprocedure•Moresurgery28daysaftertheaccident•Fixfacialfracturesandtoattempttocorrectthebilateraltelecanthusandtraumaticenophthalmos(内眦过宽与眼球内陷)•Aplasticlid(塑料眼睑)andacostochondral(肋骨软骨的)graftwereimplantedintheregionofthenasaldorsum.•Noneedtofixthemaxillabecausetheexistingmobilitywasminimal,withoutimpairingherabilitytochew(A)Angiography(血管造影术)showinggoodvascularizationofthefaceaftertraumawithpatencyofthebranchesoftheexternalcarotidartery.(B)3DCTimages,showingfracturesofthemidfaceafterthefirstsurgicalprocedure.(C)CTafterthesecondsurgicalprocedureforfixationoffracturesandreconstructionofthemidface.•Thereisnopre-establishedtreatmentprotocolforfacialdeglovinginjury.•Ensuringthepermeabilityoftheairwaysandcontrollingbleeding.•Ashorteroperationtimereducestheriskofinfectionandnecrosisandallowsfavourableconditionsforthesubsequentreestablishmentofbonestructures•Providingthepatientwithadequatefunctionandaesthetics•她是不幸中的万幸的，因为她没有出现以下两种：•较大面积的软组织缺损•严重的感染或大面积的坏死1.致伤原因：车祸2.Defectmeasuring10*14cm3.Medporimplantsand2.4mmtitaniumplate4.Freeanterolateralthighflapreconstruction(股前外侧皮瓣)3monthsafterthefreeanterolateralthighflapreconstruction.Theresultafterthecompletionofscalptissueexpansionforthehairlinereconstruction3weeksafterthereconstructionofthelefttemporalhairlinereconstructionEpidermalskingrafttakenfromthescalpandsuturedtothede-epithelizedanterolateralthighflapforbettercolormatch头皮来源的表皮移植到去表皮层的股前外侧皮瓣上，匹配颜色Thefinalreconstructiveresulttwoyearsaftertheinitialinjuries:AnobliqueviewAndAPviewAnotherCase软组织缺损伴有器官损失致伤原因：自杀未遂被狗咬伤有时候，清创也不能一次性彻底完成，需要少量多次。因为软组织缺损太多了，需要尽可能的保留。致伤原因：战场枪伤参考文献1.BergmannJ,LeeK,KleinR,etal.Upperfaceandorbitdeglovingdogbiteinjury[J].OphthalPlastReconstrSurg,2009,25(1):44-46.2.CatundaIS,deMedeirosMF,SantosLA,etal.Animpressivecaseofcompletetraumaticmaxillofacialdegloving[J].IntJOralMaxillofacSurg,2012,41(3):344-349.3.JaiswalR,PuLL.ReconstructionAfterComplexFacialTrauma:AchievingOptimalOutcomeThroughMultipleContemporarySurgeries[J].AnnPlastSurg,2013,4.OlatejuOS,OginniFO,FatusiOA,etal.Multiplemidfacedeglovinginjuryinanelderlyman:challengesandmanagementoutcome[J].JNatlMedAssoc,2007,99(7):810-813.5.PerumalC,BouckaertM,RobsonM.Deglovingfacialinjurytreatedwithhydroconductivedressing[J].AnnMaxillofacSurg,2013,3(1):87-88.6.PollockRA,HuberKM,SickelsJE.Deglovinginjuriesoftheoralcavitychangetheoperativeapproachtofracturesoftheanteriorsegmentofthemandible[J].CraniomaxillofacTraumaReconstr,2011,4(3):137-144.7.PrielA,LeelapatranurakK,OhSR,etal.Medialcanthaldeglovinginjuries:thetriadoftelecanthus,ptosis,andlacrimaltrauma[J].PlastReconstrSurg,2011,128(4):300e-305e.