颜面部软组织外伤的急诊美容修复

目的：探讨颜面部软组织外伤的最佳修复方法。方法：对2000年6月-2007年6月，急诊外科接诊的126例207处颜面部软组织外伤创面，遵循细致的清创处理原则和微创缝合技术，实施美容整形修复技术治疗。结果：126例207处损伤创口均一期愈合，78％以上的术后病例经过3个月～6个月的随访，修复伤口呈细小线状，瘢痕轻微，外观满意，五官功能不受影响。结论：颜面部软组织外伤创面及时施行急诊美容整形修复术治疗，能够达到最佳的修复效果。     

唇颏部损伤的急诊美容修复

目的总结唇颏部损伤急诊处理与美容修复的经验。方法回顾性总结2004年9月~2014年12月收治的137例185处唇颏部损伤患者的临床资料,男性89例,女性48例,年龄1~52岁,平均12.2岁。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0.2cm;若有皮肤软组织缺损,按照"宁近勿远,宁简勿繁"的修复原则,分别选择各种皮瓣修复;注重康复治疗。结果本组137例185处伤口,139处不伴组织缺损的伤口美容缝合后伤口一期愈合;38处伴组织缺损的伤口,以29个局部皮瓣、9个皮下蒂皮瓣和3个黏膜瓣修复,各组织瓣均100%成活,伤口一期愈合;5处延期修复的伤口,2处直接缝合,3处伴组织缺损者以局部皮瓣修复,伤口均一期愈合。所有伤口外形均良好,患者满意。术后3~12个月随访121例167处伤口,绝大多数瘢痕较轻,效果良好。结论在唇颏部损伤急诊处理中,遵照"创伤美容修复"理念,充分运用美学理论和整形美容外科技术,实施及时准确的治疗,即能实现美容修复的目标。     

颜面部外伤急诊美容整形修复的原则

在长期急诊外科工作中,既往经常遇到颜面部外伤缝合或修复后患者不满意的情况,给医患双方均造成了很大的遗憾。近年来在以上操作中注意遵循医学美学的原则,使Ⅰ期手术得到了满意的效果。兹就有关颜面部外伤急诊Ⅰ期美容整形修复的原则进行初步探讨。     

老虎咬伤五例治疗体会

我院自 1998年以来 ,共收治野生动物园老虎严重咬伤患者 5例。临床资料　 (1)一般资料 :本组男 4例 ,女 1例 ;年龄 2 0～ 3 3岁 ,平均 2 5 .8岁。受伤部位 :左膝部咬伤 1例 ,伤口深达股骨内外髁 ,股直肌内外侧头部分断裂 ,外髁有一小块骨皮质游离 ,未达膝关节 ;左前臂咬伤 1例 ,伤口深达桡骨 ,伸屈肌肌腹部分断裂 ,有 3ｃｍ× 4ｃｍ皮肤缺损 ;右上臂咬伤 1例 ,伤口深达肱骨 ,肱二头肌及三头肌部分断裂 ,桡神经挫伤 ;右小腿咬伤 2例 ,伤口深达胫骨后方 ,腓肠肌及腓骨长短肌部分断裂。 (2 )治疗方法 :左膝部咬伤患者 ,行局麻下清创Ⅰ期缝合伤…     

优拓油纱用于犬咬伤创口引流的效果观察

目的探讨优拓油纱对犬咬伤创面的治疗效果。方法选取240例犬咬伤致皮肤贯穿需清创缝合的患者,随机分为A组(对照组)和B组(试验组)各120例。A组伤口经清创缝合术后采用传统凡士林油纱引流,B组伤口经清创缝合术后采用优拓油纱引流。观察创面感染率,比较更换引流物的次数和创面愈合时间。结果与A组的治疗方法相比,B组患者的伤口感染率明显降低,引流物的更换次数明显减少,且伤口的愈合时间明显缩短,差异均有统计学意义(P<0.05)。结论优拓油纱较传统的犬咬伤伤口引流物能够加速犬咬伤创面愈合,提高治愈率。     

双层缝合法预防颜面部瘢痕形成

随着生活水平的提高和社会交往增多,人们不断追求更完美的仪表,更注重美容。因此,对于不慎发生颜面部外伤者,都希望减少畸形及瘢痕的发生。笔者自1993年以来进行了一些减轻瘢痕办法的探讨,其中以双层缝合法效果较佳,特报道如下。     

局部皮瓣Ⅰ期修复面部咬伤所致大面积皮肤缺损的体会

颜面部咬伤创口污染常较严重,因此修复的时机选择,一直是人们关注的问题.自2002年以来,我院共收治人及各种动物咬伤42 例,对其中 28例患者采用Ⅰ期局部皮瓣转移修复创口,取得了较好疗效.现将我们的治疗体会分析报告如下.     

卫生板报

<正>被动物咬伤后一定要注射狂犬疫苗狂犬病是人畜共患的急性传染病,病死率极高,一旦发病,几乎百分之百死亡。能传播狂犬病的动物有狗、猫、蝙蝠、狐狸、狼、猫鼬、浣熊、臭鼬及老鼠等啮齿类动物,被这些动物咬伤、抓伤,就一定要及时进行伤口处理和疫苗注射,切莫存有侥幸心理,以免造成不可挽回的悲剧。一旦被狗、猫咬伤,不要急于去医院找医生诊治,而是应该立即就地、彻底冲洗伤口(咬伤和抓伤处)至少15分     

XH-超高频皮肤整形手术仪治疗创伤缝合瘢痕380例

大部分伤员清创后对皮肤的处理多为非美容整形外科缝合 ,以至于创面对位不好 ,皮肤愈合后凸凹不平或出现增生性瘢痕 ,或由于针角大 ,皮肤愈合后出现虫足样变化 ,如在颜面部则严重影响美观。为满足此类伤员对容貌的要求 ,1999年 4月～ 2 0 0 2年4月 ,我们采用ＸＨ 超高频皮肤整形手术仪对创伤缝合瘢痕 380例进行了系统治疗 ,效果满意。1　临床资料1 1　一般情况　 380中男 2 4 8例 ,女 132例 ,绝大多数缝合瘢痕长 2～ 15ｃｍ ,有 1例长达 4 0ｃｍ以上。颜面部瘢痕 78% ,其他部位 2 2 % ;创伤 2年以上者 4 3 0 % ,2年以内者 5 7 0 %。多数在创…     

汶川地震中颜面部创伤的处理原则

目的 调查分析汶川地震中涉及耳鼻咽喉颜面部外伤伤员的伤情及治疗情况,探讨更有效地处理针对地震造成的颜面部外伤的方法.方法 对在解放军第452医院住院治疗的165例汶川地震伤员进行专科检诊,重点对合并耳鼻咽喉颜面部损伤的伤员伤情进行统计分析,并根据伤情分别给予清创缝合或整形缝合、骨折复位及固定、局部及全身抗感染治疗.对其治疗后2周的效果进行随访观察.结果 165例伤员中合并颜面部损伤伤员33例(20%),包括耳部外伤10例(6.1%)、鼻部外伤8例(4.8%)、口唇撕裂伤2例(1.2%),经治疗后伤口均一期愈合,无毁容病例;鼻窦及颧骨骨折8例(4.8%)、下颌骨骨折5例(3.0%),治疗后患者恢复良好,目前仍在随访中;无咽喉部、颈部及气管食管外伤者.伤后并发感染者(非院内感染)6例(3.6%),无死亡病例.结论 专科医生应早期、恰当地处理地震所造成的颜面部外伤,除了重建功能以外,恢复患者的正常形态(容貌)同样重要.     

War injuries of blood vessels of the extremities

Treatment results of 200 injured with the lesions of 282 magistral blood vessels were analyzed. All were combat injuries, and the majority was caused by the fragments of explosive device. The mechanisms of such the injuries produced large defects of soft tissues as well as the high level of the wound contamination, which aggravated reconstructive procedures and increased the risk of infection. In the majority of cases anatomic reconstruction of the artery was performed, and the ligature was used only in the case of graft infection and in the injuries of one artery of the lower leg or the forearm. The majority of injuries was solved by lateral suture or patch plastic, since postoperative constriction caused by those methods did not cause greater hemodynamic disorders due to the size of venous lumen. The duration of ischemic interval was of the utmost importance for the favorable final result of the treatment, as well as the adequate debridement of the wound, good soft-tissue cover of the reconstructed blood vessel and precise atraumatic technique. Total percentage of amputations was 14.5%, and all were involving the lower extremities, and were mostly caused by popliteal artery lesion.     

Reconstruction of devastating head injuries: a useful method in forensic pathology

Crushing head injuries usually do not allow direct visual identification of individuals, and above all, it constitutes an obstacle to comprehensive evaluation of discrete traumatic changes of the skin and soft tissues. We present our experience with the plastic adaptation of devastating head injuries in the two exemplary cases. The principal of the reconstruction is manual repositioning of bone fragments of the cranial and facial parts of the skull and careful approximation of the wound edges and their gradual suture using suture material. The reconstruction method can be recommended as an auxiliary technique in the identification of unknown victims with crushing head injuries and in the evaluation of devastating gunshot wound of the head.     

系统护理对高压氧联合整复手术治疗唇裂患儿康复效果的影响

目的 探讨系统护理对唇裂患儿术后唇组织结构畸变及唇部伤口疤痕的影响.方法 分析影响唇裂手术后伤口畸变及皮肤疤痕形成的因素,有针对性地提出了唇裂手术伤口系统护理的方法,主要包括高压氧辅助下的伤口持续性减张、使用上皮生长因子湿敷、持续性地保持伤口清洁3个方面.结果 经临床使用和统计学分析比较发现,系统护理组唇组织恢复率(9...     

皮肤良性肿瘤手术切除后创面美容修复的探讨

目的:探讨皮肤良性肿瘤切除后创面美容修复的方法。方法:肿瘤病灶切除后根据创面部位、大小、深度,遵照"宁近勿远,宁简勿繁"的原则,选择适宜的皮瓣、肌皮瓣或皮片修复创面;创面位于功能部位者采用分区植皮技术。所有伤口局部均实施康复治疗。结果:皮片移植的721例中,684例自供皮区切取移植的中厚或全厚皮片成活率均在95%～100%;37例取自切除肿瘤组织表面皮肤的中厚皮片,27例成活率为70%～90%,10例经二期手术植皮愈合,该27例局部有瘢痕形成。166例采用各种皮瓣或肌皮瓣修复创面者,除2例皮瓣全部坏死,二期行皮片移植修复创面外,其余164个各种皮瓣均100%成活,161例术区外形与功能均满意。病灶摘除或切除后伤口直接缝合者230例中,伤口均一期愈合,226例局部无明显瘢痕增生与色素沉着。本组美容修复率达到96.8%。结论:采用美学理论和整形美容技术修复皮肤良性肿瘤切除后,创面可以达到美容修复的目的。     

儿童颜面部软组织创伤的急诊早期整复

目的:探讨儿童颜面部软组织创伤急诊早期整复的疗效.方法:在局麻或全麻下行创面清创后,按整形外科原则早期分别行直接缝合术、局部皮瓣修复术、全厚皮片修复术,术后用美宝疤痕平软膏外涂.结果:所有创面均Ⅰ期愈合,术后6个月随访,创面瘢痕不明显,外观及功能无明显影响.结论:早期应用整形外科原则进行修复,术后用美宝疤痕平行预防瘢痕治疗,对儿童颜面部软组织急诊创伤术后的外观及功能恢复有理想的效果.     

周围血管损伤的诊断和治疗

周围血管损伤的诊断主要依靠病史和临床检查。必要时可以辅助以彩色多谱勒超声检查和血管造影。急救原则：首先是止血、抗休克、挽救生命,其次修复血管、重建血循环、保存肢体,兼顾功能。血管损伤修复的方法：侧壁修补、端一端吻合、端一侧吻合、侧一侧吻合以及局部缺损等方法。血管缺损修复的方法：游离血管、屈曲关节、血管交叉缝合法、利用损伤的动脉移植、静脉移植、旁路血管移植和带血管蒂的轴型皮瓣游离移植。血管移植的材料：自体血管、人造血管、人脐带血管以及用塑料管作暂时性动脉分流。     

The management of facial injuries in rugby union

Background: There are as yet no guidelines in rugby union for the management of facial lacerations which account for one-third of total injuries sustained by players.

Method: We devised a questionnaire to establish the current standards in rugby union clubs in England. The questionnaire covered such issues as inadequate wound cleansing, inappropriate suture material, the use of sterile suture equipment, and advice required for suture removal.

Results: We recommend that a dedicated medical room should be available in all clubs, the doctor should always wear gloves, and local anaesthetic and sterile suture packs and instruments should be provided.

     

Frequency, etiology, localization and surgical treatment of war injuries with tissue defects

The retrospective analysis of 1,514 cases treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy in the period between 1991 and 1995, established that the percentage of the injuries caused by gunshots and those caused by explosives during the conflict in former Yugoslavia, was more or less the same. The injuries caused by gunshot more often occurred on the head, neck, arms and trunk. The injuries of the legs caused by the explosives were more frequent, and they occurred in 83% of the cases. All the plastic surgeons who took part in the treatment of patients and in preparing the surgeons of other specialties for the treatment applied the original classification of the war injuries according to the structure of the defects that had occurred, to standardize the approach to the planning of treatment and the treatment itself of the wounded. In the delayed primary or secondary treatment of the injuries with the tissue defects all known plastic and reconstructive methods were applied. In the cases requiring the covering of the the tissue defect with the full thickness skin, local skin, fasciocutaneous, fascioadipose or muscle flap was chosen. Distant pedicled direct flaps were used in cases when it was not possible to use a more suitable reconstructive method. Free skin, myocutaneous or complex microvascular flaps were applied in cases of more extensive defects or if a more suitable solution could not be found. Our experience in surgical treatment of war injuries with skin defects during the civil war in former Yugoslavia has shown that over 50% of all the injured patients required the treatment of a plastic surgeon in a definite surgical treatment of a war injury. A multidisciplinary approach is necessary in the majority of the injured, and the surgical team is composed according to the affected area and the extent of the injury.