摘要
目的探讨伴有颅内损伤的头面部毁损伤早期采用游离皮瓣修复皮肤软组织缺损的临床疗效。方法回顾性分析2015年1月至2021年1月空军军医大学西京医院烧伤与皮肤外科重症监护室收治的18例伴有颅内损伤的头面部严重毁损伤患者,所有患者均存在头面部皮肤软组织缺损,颅内损伤包括脑挫裂伤10例,硬膜下血肿4例,蛛网膜下腔出血2例,脑挫裂伤合并硬膜下血肿1例,颅底骨折1例。入院后早期(18~72 h)手术清创,采用游离皮瓣修复缺损创面,18例患者共计19个皮瓣,分别为行背阔肌皮瓣转移患者8例,股前外侧皮瓣转移患者9例,股前外侧加前臂桡动脉穿支皮瓣转移患者1例,皮瓣面积11 cm×6 cm~26 cm×15 cm。结果所有患者颅内损伤情况稳定,未出现进展性加重情况,移植皮瓣全部成活,头面部外观得到较大改善,无严重并发症发生。结论伴有颅内损伤头面部毁损伤,早期清创,并采用以显微外科为基础的游离皮瓣移植修复能取得较好效果,未出现严重并发症。
Objective To explore the clinical efficacy of repairing skin and soft tissue defects with free flap in early stage of head and face injury accompanied with intracranial injuries.Methods From January 2015 to January 2020,18 patients with head and face injury accompanied with intracranial injuries were admitted to the intensive care unit of Department of Burns and Cutaneous Surgery,Xijing Hospital,Air Force Medical University.All patients had severe skin and soft tissue defects of head and face.Intracranial injuries included cerebral contusion and laceration in 10 cases,subdural hematoma in 4 cases,subarachnoid hemorrhage in 2 cases,cerebral contusion and laceration with subdural hematoma in 1 case,and skull base fracture in 1 case.In the early stage(18~72 h)after admission,the defects were repaired with free flap following debridement.There were 19 flaps used in the 18 cases,including 8 latissimus dorsi flaps,9 anterolateral femoral flaps and 1 anterolateral femoral plus radial artery perforator flap.The area of flaps ranged from 11 cm×6 cm to 26 cm×15 cm.Results All patients had stable intracranial injuries without progressive aggravation.All transplanted flaps survived,the appearance of head and face was greatly improved,and no serious complications occurred.Conclusion After the early debridement of head and face injury accompanied with intracranial injuries,the injury can be repaired by free flap transplantation based on microsurgery.The treatment can achieve a good result without serious complications.
作者
侯宏义
郭凯
郑朝
韩军涛
谢松涛
HOU Hongyi;GUO Kai;ZHENG Zhao;HAN Juntao;XIE Songtao(Burns Center of PLA,Department of Burns and Cutaneous Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)
出处
《空军军医大学学报》
CAS
2023年第3期262-265,共4页
Journal of Air Force Medical University
基金
国家自然科学基金面上项目(81372056)。
关键词
头面部损伤
毁损伤
颅脑损伤
早期修复
游离皮瓣
head and face injury
destructive injury
craniocerebral injury
early repair
free flap