Doctor Vishal S, Farwell D Gregory
Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA.
Curr Opin Otolaryngol Head Neck Surg. 2007 Aug;15(4):213-8. doi: 10.1097/MOO.0b013e3281fbd3ef.
Gunshot wounds to the head and neck result in significant bone and soft tissue loss. These defects pose a challenge to the facial reconstructive surgeon. This paper reviews the current literature on the management of ballistic injuries to the head and neck and outlines a treatment algorithm.
With recent advances in free tissue transfer, early definitive reconstruction of bone and soft tissue deficits with vascularized flaps has become the treatment of choice. Computed tomography angiography of the neck has been shown to be a sensitive, specific, and safe technique in screening for vascular injuries.
Management of ballistic injuries to the head and neck begins with advanced trauma life support protocols. Computed tomography angiography is now widely available and provides an accurate and rapid evaluation of head and neck vasculature. The initial operation aims to establish occlusion, stabilize bone and close soft tissue defects. Serial debridement of wounds with delayed reconstruction has given way to early definitive repair with vascularized tissue. This has led to improved function, fewer operations, and shorter hospital stays.
头颈部枪伤会导致严重的骨骼和软组织缺损。这些缺损给面部重建外科医生带来了挑战。本文综述了当前关于头颈部弹道伤治疗的文献，并概述了一种治疗方案。
随着游离组织移植技术的最新进展，使用带血管蒂皮瓣早期确定性重建骨骼和软组织缺损已成为首选治疗方法。颈部计算机断层血管造影已被证明是一种筛查血管损伤的敏感、特异且安全的技术。
头颈部弹道伤的治疗始于高级创伤生命支持方案。计算机断层血管造影现已广泛应用，可对头颈部血管系统进行准确、快速的评估。初始手术旨在实现血管闭塞、稳定骨骼并闭合软组织缺损。伤口的系列清创术及延迟重建已被早期使用带血管组织的确定性修复所取代。这带来了功能改善、手术次数减少和住院时间缩短的效果。
