颌面部爆炸伤软组织缺损早期修复的实验研究

将犬随机分为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。Ａ组伤后即刻清创、隐动脉皮瓣立即移植修复皮肤缺损；Ｂ组伤后即刻清创，７２ｈ后二次清创，同时切取隐动脉皮瓣，吻合血管修复皮肤缺损，颊粘膜缺损两组均行局部拉拢缝合。术后观察１～６个月，Ａ组５例均失败；Ｂ组１５例，成功１２例，游离皮瓣成活率为８０％。实验结果表明口腔颌面部爆炸伤软组织缺损经早期清创，７２ｈ后扩创，用吻合血管游离皮瓣修复是可行的。

An experimental study of early reconstruction for oromaxillofacial soft tissue defect due to blast injury

The possibility and method of early reconstruction for oromaxillofacial soft tissue defect resulted from blast injury in dogs were studied. 20 dogs were divided randomly into two groups and wounded in the left maxillofacial region by model KTY-04 electric detonator exploded with a 0.1cm distance. As a result, there was a hole in the left cheek of the dogs. In group A,debridement was performed immediately and the skin defect of the left cheek was repaired with saphenous artery skin flap soon after. In group B,the immediate surgical debridement was taken and it was repeated 72 hours after wounding. Meanwhile, saphenous artery skin flap was excised and used to repair the similar skin defect with microvascular anastomosis. Every defect of the mucous membrane in the two groups was repaired by drawing the adjacent mucous membrane together. The dogs were observed for 1 to 6 months postoperatively. All the 5 free flaps in group A died completly. However, the survival rate of the free skin flaps in group B was 80% (12/15). The experimental result shows that early reconstruction for oromaxillofacial soft tissue defect caused by blast injury is possible. The immediate and second expansive debridement is necessary for the early repair. Transfer of the free flap by microvascular anastomosis is an effective method of early reconstruction for this defect.