岛状胸大肌肌皮瓣修复颈前雷管炸伤一例

GREAT PECTORAL MUSCLE ISLAND FLAP FOR REPAIRING DETONATOR EXPLOSION WOUND

作者治疗一例颈前雷管炸伤,48小时后住院。患者自颈前上1/2至颌下区深达咽喉开放创口,其间组织荡然无存,气管残端在甲状腺区下部开放,污染严重。入院后先行输液,输血后行手术治疗。全麻下清创,用右侧胸锁乳突肌残余肌瓣及左胸锁乳突肌内侧头肌瓣修补咽喉腔,气管残端开放於重建之咽喉腔内,然后采用右侧胸大肌区之肌皮瓣,并带胸大肌胸骨部肌瓣及血管神经蒂,於隧道下拉出创口行缝合修补,并放置引流,9日拆线一期愈合。预计半年后行喉再造。作者最后进行了讨论。附有像片(手术前后比较)

The authors treated a case of neck injury caused by detonator explosion. The patient was hospitalized 48 hours after injured. There was an open wound involving half of the upper anterior part of the neck and the submaxillary region, with a depth to the throat. All the tissues in the wound had gone. The stump of the trachea was exposed at the lower part of the thyroid gland and was severely contaminated. The patient was submitted to liquid infusion upon admission to the hospital and was then operated on. Debriedement was done under general anesthesia and the throat cavity was repaired using right side sternocleidomastoid muscle residual muscular flap and left side sternocleidomastoid muscle flap. The tracheal stump was reconstructed in the throat cavity and the wound was then pulled out under the channel and was sutured using right great pectoral muscle flap and the muscle flap from sternal part of great pectoral muscle and vascular nerve pedicle and was left to drain. 9 days after operation, the stitches were removed and the wound healed by first intention. The reconstruction of the throat was expected to be done in half a year. A discussion was made.