面部创伤的急诊处理与美容修复

Emergency treatment and cosmetic repair of facial trauma

目的总结面部创伤急诊处理与美容修复的经验。方法回顾性总结2010年1月～2012年8月兰州军区兰州总医院全军烧伤整形外科中心治疗291例584处面部创伤患者的临床资料。遵照医学美学和整形美容外科原则，不刻意强调清创时机，采用高压冲洗技术彻底清创；若无皮肤软组织缺损，采用新的缝合技术分层严密缝合，针距和边距为0．2～0．3cm；若有皮肤软组织缺损，按照“宁近勿远，宁简勿繁”的修复原则，分别选择全厚皮片或各种皮瓣修复；注重康复治疗。结果清创后直接缝合328处，全厚皮片移植147处，各种皮瓣修复109处。571处伤口一期愈合，愈合率为97．8％，伤口对合良好，无明显瘢痕、五官无错位与变形。其余13处因移植皮片或皮瓣成活不良或伤口裂开，4处行二次手术修复创面，9处经换药愈合，经积极康复治疗，该13处瘢痕增生和色素沉着比较轻。217例患者454处面部创伤随访3～13个月，外观良好，瘢痕增生轻微，11处移植皮片存在不同程度的色素沉着；此外，12例存在眉部分缺失，耳郭完全或部分缺失。结论在面部创伤急诊处理中，遵照“创伤美容修复”理念，充分应用美学理论和整形美容外科技术，发挥多学科合作，实施及时准确的治疗，就能实现美容修复的目的。

Objective To summarize the experience of emergency treatment and cosmetic repair of facial trauma. Methods The clinical materials of 584 wounds from 291 cases of facial trauma, recruited in hospital from January 2010 to August 2012, were summed up retrospectively. The principles of medical aesthetics and plastic and cosmetic surgery were followed. A high pressure douching technique was employed to carry out thorough debridement, but occasion of the debridement did not emphasize with intensive attention. A wound without skin and soft tissue defect was sutured accurately according to tissue zonation with a new suture technique, and the needle distance or side distance was limited in 0.2 cm to 0.3 cm. Otherwise, the wound was repaired by full-thickness skin graft or various flaps according to the repair principle of ＂rather near than further, rather simple than complicated＂. Attention was paid to rehabilitation care. Results After debridement, 328 wounds were sutured directly, 147 wounds were repaired by full-thickness skin grafting and 109 wounds by various flaps. A total of 571 wounds healed on the first stage, and the healing rate reached 97.8%. The wounds were in satisfactory apposition and without obvious cicatrix. Five senses did not appear in malposition and deformity. The other 13 wounds did not heal because of bad taking of skin grafts and flaps or wound splitting. Among them, 4 wounds were repaired by second operation, and 9 wounds healed by changing dressings. By means of rehabilitation care, scar hyperplasia and pigmentation appeared slightly in those 13 wounds. A total of 454 wounds from 217 cases were followed up. The results showed good appearance and slight cicatrix hyperplasia, a pigmentation in different degree appeared in 11 wounds covered by skin grafting. In addition, eyebrow excalation, auricle excalation or total lose appeared in 12 cases. Conclusion During treating emergency cases of facial injuries, if an idea ＂cosmetic repair of trauma＂ is followed, the theory of aesthetics and the techniques of plastic and cosmetic surgery are fully used, a multiple-discipline cooperation is brought into full play, and a prompt and accurate treatment is put into practice, the aim of cosmetic repair would come true.