Vitkus K, Vitkus M
Microsurgical Laboratory, Vilnius University, Lithuania.
J Reconstr Microsurg. 1990 Jul;6(3):279-86. doi: 10.1055/s-2007-1006831.
Successful management of shotgun-blast injuries to the face with loss of composite tissue is discussed. While emphasis in the literature has generally been on weapons ballistics and their destructive effect on tissues, the most massive tissue destruction can be anticipated from close-range gun-barrel effects due to rapidly expanding gases. The authors stress uncommonly aggressive tissue transfer as the method of choice in reconstructing facial shotgun wounds. The surgeon must evaluate patient psychological readiness for step-by-step reconstruction. Fistulas are avoided by transplanting several small flaps, rather than one large flap. The dorsalis pedis flap is recommended as an excellent choice for contaminated intraoral reconstruction. A staged approach providing osteocutaneous composite tissue for repair of shotgun-blast facial wounds is presented. At subsequent stages, soft tissue defects are repaired and restoration of mandibular continuity is provided with the use of the scapular flap and other alternatives. Microsurgical management of facial gunshot wounds can provide satisfactory reconstruction and almost normal function.
本文讨论了面部复合组织缺失的霰弹枪伤的成功治疗方法。虽然文献中通常重点关注武器弹道及其对组织的破坏作用，但由于气体快速膨胀产生的近距离枪管效应，预计会造成最严重的组织破坏。作者强调，在重建面部霰弹枪伤时，非常规的积极组织转移是首选方法。外科医生必须评估患者对逐步重建的心理准备情况。通过移植多个小皮瓣而非一个大皮瓣来避免瘘管形成。对于受污染的口腔内重建，推荐使用足背皮瓣。本文提出了一种分阶段方法，用于提供骨皮复合组织修复霰弹枪所致面部伤口。在后续阶段，修复软组织缺损，并使用肩胛皮瓣及其他替代方法恢复下颌连续性。面部枪伤的显微外科治疗可实现满意的重建和几乎正常的功能。
