Perumal Colin Jerome, Robson Martin
Eplasty. 2012;12:e32. Epub 2012 Jul 25.
Traumatic avulsive injuries present complex therapeutic decisions. Radical and repeated debridement of all foreign material, necrotic tissue, bacteria, and deleterious chemicals followed by control of the bacterial bioburden and wound closure has been the gold standard. However, when such injuries occur in the face, the treatment requires modification. Specialized structures, nerves, and a maximum amount of tissue must be preserved. Topical antimicrobials may lead to dessication and further injury to tissue. Therefore, alternative treatments must be considered. Recently, a hydroconductive dressing has been demonstrated to decrease edema by removing excess exudate, to remove debris and necrotic tissue, and to decrease bacteria and deleterious cytokines in wounds.
Regular dressings were done between 1 and 3 days by dedicated personnel, using a hydroconductive dressing. Following an initial conservative debridement and reconstruction while attempting to preserve as much of the normal structure as possible, the wounds were dressed with a hydroconductive dressing.
Using only selective conservative debridement following bony reconstruction and repeated hydroconductive dressing changes, this severe injury healed with preservation of the important facial features. No further extensive surgical procedures were required. On discharge, the patient was able to function well with a reasonably good aesthetic result. She was subsequently lost to follow-up.
This case report demonstrates that a hydroconductive dressing can be useful for traumatic avulsive injuries.
创伤性撕脱伤带来了复杂的治疗决策。对所有异物、坏死组织、细菌和有害化学物质进行彻底且反复的清创，随后控制细菌生物负荷并闭合伤口，一直是金标准。然而，当此类损伤发生在面部时，治疗需要调整。必须保留特殊结构、神经以及最大量的组织。局部抗菌药物可能导致组织干燥和进一步损伤。因此，必须考虑其他治疗方法。最近，一种导水敷料已被证明可通过清除过多渗出液来减轻水肿，清除碎屑和坏死组织，并减少伤口中的细菌和有害细胞因子。
由专业人员每隔1至3天使用导水敷料进行常规换药。在进行初步保守清创和重建，同时尽可能保留正常结构后，伤口用导水敷料包扎。
仅在骨重建后进行选择性保守清创并反复更换导水敷料，这种严重损伤得以愈合，重要面部特征得以保留。无需进一步进行广泛的外科手术。出院时，患者功能良好，美学效果相当不错。她随后失访。
本病例报告表明，导水敷料可用于创伤性撕脱伤。
