颌面部爆炸伤区血管早期吻合的病理学基础

目的：探讨颌面部爆炸伤区血管的组织学改变与早期血管吻合的关系。方法：将犬随机分成A（即时）组、B（72h)组，采用KTY－04型雷管置于犬面颊部引爆致伤，造成软组织洞穿性缺损。分别切除两组颌面部爆炸伤区距创缘不同距离处的血管标本行光、电镜观察，并且行吻合血管的游离皮瓣移植，术后1周－3月切取各血管吻合口处标本观察组织学变化。结果：A组距创缘3cm处的血管内皮细胞大部分脱落，平滑肌细胞变性，动脉内弹力膜大部分消失；5例血管吻合皮瓣移植均失败。B组距创缘3cm处血管内膜较完整，平滑肌细胞基本恢复正常，内弹力膜大部分恢复；15例血管吻合皮瓣移植成功12例。结论：颌面部爆炸伤后3d,伤区外3cm血管开始恢复正常，此时行血管吻合游离皮瓣移植有其病理学基础。

PATHOLOGICAL FOUNDATION OF EARLY ANASTOMOSIS OF BLOOD VESSEL IN MAXILLOFACIAL BLAST WOUND REGION IN DOGS

Objective :To understand the relationship between the pathological changes of blood vessel and their early anastomosis in maxillofacial blast wound region. Method :20 dogs were divided randomly into two groups and wounded in the left maxillofacial region by model KTY-04 electric detonator exploded. When debriding, the blood vessels in maxillofacial blast wound region were removed at different distances and different times in order to observe their pathological changes. After debriding, the blood vessels were anastomosed and saphenous artery skin flaps were transplanted. Result :In group A, it was discovered that part endothelial cells of the blood vessels at 3cm from the wound edge fall off, most endoarterious elastic membrane disappear, and 5 free flaps die completely(5/5).However, in group B,the blood vessels endothelial cells were almost complete, and most endoarterious elastic membrane recover. 12 free flaps of 15 ones were successful. Conclusion :The blood vessels at 3cm from the wound edge of maxillofacial blast wound region begin to recover in 3 days after wounds, which is the key of successful and anastomosis for the free flap.