口腔颌面部爆炸伤与枪弹伤的对比实验研究

Comparison of experimental study of oromaxillofacial blast injury and firearm injury

目的 比较两种不同类型的颌面部火器伤的损伤特点及救治方法。方法 将实验犬分为A(爆炸致伤)组及 B(枪弹致伤)组,分别采用KTY 04型雷管及M16步枪发射5.56mm弹丸致伤犬左面颊部。创区均采用游离皮瓣一期移植修复。结果 两组犬左颊部软组织均呈洞穿性缺损。A组创口入口口径大于出口口径;B组则为出口大于入口。两组犬伤后伤口均感染,2次清创后感染率差别明显;而血管吻合口的病理改变及皮瓣成活率相近。结论 颌面部爆炸伤与枪弹伤伤情均较重,损伤特点有所差异。两组犬颌面部软组织缺损伤后3d行早期修复都是可行的。吻合血管的游离皮瓣移植是有效而较好的方法。

Objective To compare the local changes,possibility and method of early reconstruction for oromaxillofacial soft tissue defect resulted from blast injury or firearm injury in dogs.Methods Fifteen dogs were wounded in the left maxillofacial region by model KTY-04 electric detonator exploded with a 0.1 cm distance; eight dogs were wounded in same region by the high velority missile that was shot by M-16 rifle. All skin defects of the left cheek were repaired by saphenous artery skin flap 72h after wounding.Results There was a pass-through defect in the left cheek of every dog. In group A,the calibre of entrance was bigger than that of exit in every wound. But in group B, it held opposite views.All wounds were infected after injury.Change of the edge of blood vessel for anastomosis and the survival rate of the skin flaps were similar between two groups;but the rates of infection after second debridement were different.Conclusion Neither blast injury nor firearm injury was seriously wounded in maxillofacial region. The features of injury were differential between them. However,early reconstruction for oromaxillofacial soft tissue defect caused by blast injury or firearm injury are possible.Transfer of the free flap by microvascular anastomosis is an effective and better method.