Demetriades D, Chahwan S, Gomez H, Falabella A, Velmahos G, Yamashita D
Department of Surgery, University of Southern California, Los Angeles 90033, USA.
J Trauma. 1998 Jul;45(1):39-41. doi: 10.1097/00005373-199807000-00007.
The literature on early management of gunshot wounds (GSWs) to the face is scant, with only six series reported in the English-language literature in the last 12 years. In the current study, we present a large series from a busy trauma center in an effort to identify early diagnostic and therapeutic problems and recommend management guidelines.
Retrospective analysis was done for all GSWs of the face during a 4-year period. Data were obtained from the Trauma Registry and Trauma Patient Summary hard copies.
During the study period, there were 4,139 admissions for GSWs, with 247 (6%) involving the face. An associated brain trauma was found in 42 patients (17.0%), and cervical spine fracture was found in 20 patients (8.1%) with GSWs to the face. In 43 patients (17.4%), there was a need for emergency airway control because of local hematoma or edema. Angiography was performed in 70 patients (28.3%) for evaluation of a large hematoma or continuous bleeding, and in 10 of these patients successful embolization of bleeders was achieved. No patient required operative control of bleeding from facial structures. Overall, only 96 patients (38.9%) underwent operation for soft-tissue repair or reduction of facial bone fractures. There were 36 deaths (14.5%) from severe brain injury or severe bleeding from associated chest or abdominal injuries. No death occurred in isolated GSWs to the face.
Most civilian GSWs can safely be managed nonoperatively. Airway control is required in a significant number of patients and should be established very early. Bleeding from the face is best controlled angiographically. The brain and cervical spine should be aggressively assessed radiologically because of the high incidence of associated trauma.
关于面部枪伤早期处理的文献较少，在过去12年的英文文献中仅报道了6个系列。在本研究中，我们展示了来自一家繁忙创伤中心的大量病例系列，以确定早期诊断和治疗问题并推荐处理指南。
对4年期间所有面部枪伤进行回顾性分析。数据从创伤登记处和创伤患者总结硬拷贝中获取。
在研究期间，有4139例因枪伤入院，其中247例（6%）涉及面部。42例（17.0%）面部枪伤患者伴有脑外伤，20例（8.1%）伴有颈椎骨折。43例（17.4%）患者因局部血肿或水肿需要紧急气道控制。70例（28.3%）患者进行了血管造影以评估大血肿或持续出血，其中10例患者成功栓塞了出血点。没有患者需要对面部结构出血进行手术控制。总体而言，只有96例（38.9%）患者接受了软组织修复或面部骨折复位手术。36例（14.5%）患者因严重脑损伤或相关胸部或腹部损伤严重出血死亡。单纯面部枪伤无死亡病例。
大多数平民面部枪伤可安全地进行非手术处理。大量患者需要气道控制，应尽早建立。面部出血最好通过血管造影控制。由于相关创伤发生率高，应积极进行脑部和颈椎的放射学评估。
