面横裂修复方法与修复效果的关系分析

Clinical observation of repair transverse facial cleft by surgery

目的:通过对不同手术方法修复面横裂病例的术后分析,希望找到一个面横裂修复的较为理想方法。方法:收集本科2010～2012年的17例面横裂患儿资料,年龄3个月～1岁,全麻下采用粘膜直线法,肌层功能修复,皮肤对偶三角交叉皮瓣修复7例;粘膜及皮肤均用对偶三角交叉皮瓣修复5例;粘膜及皮肤均为直线法修复5例。结果:所有病例伤口愈合良好,无口角裂开。术后随访6个月以上,患儿两侧口角位置基本对称,形态良好,瘢痕收缩不明显,粘膜及皮肤均为直线法修复5例中有2例皮肤可见轻微线状凹陷。粘膜及皮肤均用对偶三角交叉皮瓣修复5例,其中3例术后1周左右口内粘膜创口部分充血糜烂。结论:面横裂采用粘膜及皮肤均用对偶三角交叉皮瓣修复方法稍为复杂;粘膜及皮肤均为直线法修复,皮肤可能会出现线状凹陷;粘膜直线法、肌层功能修复、皮肤对偶三角交叉皮瓣修复效果良好,简单实用。

Objective To search the proper repair strategy by analyzing cosmetic effects after transverse facial cleft surgery. Methods 17 cases of transverse facial cleft were repaired by surgery. Patient data were collect from database 2010N2012,average age was 3 months to1 year old.7 cases were repaired by using direct mucosa suture,muscle function repair and symmetric triangular flap in repairing skin cleft.5 cases were repaired by symmetric triangular flap in skin and mucosa cleft.5 cases were repaired by direct suture in skin and mucosa cleft. Results Primary healing was observed in all 17 cases,none wound secondary cleft was observed.All cases follow up to 6 months. 15 cases were repaired cosmetically.2 cases by direct skin and mucosa suture were found slightly sunk healing.3 of 5 cases which were repaired by symmetric triangular flap in skin and mucosa had partial congestion and anabrosis 1 week after surgery. Conclusion Repair by symmetric triangular flap in skin and mucosa cleft cost too much anesthesia time surgery skill.Repair by direct suture in skin and mucosa cleft may cause sunk wound.Repair by using direct mucosa suture, muscle function repair and symmetric triangular flap in repairing skin cleft is the better strategy.