颌面部爆炸伤软组织缺损早期修复的实验研究

Early reconstruction for soft tissue defect in maxillofacial explosive injury

目的 :研究颌面部爆炸伤软组织缺损早期修复的可行性。方法 :15只犬随机分为A(6h)组、B(72h)组。采用雷管爆炸模拟爆炸性武器产生的冲击波 ,滑膛枪发射钢珠模拟爆炸破片 ,在同步系统控制下致犬左咬肌区破 -冲复合伤软组织缺损。A组伤后 6h初次清创后组织缺损立即用组织瓣游离移植修复 ,B组伤后 72h二次清创后同样方法修复。观察术后皮瓣成活情况。结果 :A组 3例均失败。B组 12例 ,成功 9例 ,皮瓣成活率 75 %。结论 :颌面部爆炸伤软组织缺损经初期清创、72h二次扩创早期修复是可行的 ,吻合血管游离组织瓣移植是早期修复该种缺损的有效方法之一。

Objective: To study the possibility and method of early reconstruction for soft tissue defect in maxillofacial explosive injury. Method: 15 dogs were randomly divided into group A(3 dogs) and group B(12 dogs). Steel sphere shot by smooth bore barrel and detonator were used to simulate the 2 major causative factors, fragment and blast wave, of explosive injury. The left maxillofacial region was used as the target. As a result, there was a softtissue defect in each dog. In group A, debridement was processed 6 h after injury and the soft tissue defect was soon repaired by vascularized free flap. In group B, debridement was repeated 72 h after injury and the reconstruction was done with the same method. All the animals were observed for 2 or 4 weeks postoperatively. Results: All flaps(3/3) in group A failed to survive while the survival rate of flaps in group B was 75%(9/12). Conclusions: Reconstruction in 72 h for maxillofacial soft defect with vascularized free flap is feasible in serious maxillofacial explosive injury.