Siberchicot F, Pinsolle J, Majoufre C, Ballanger A, Gomez D, Caix P
Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Universitaire de Bordeaux, France.
Ann Chir Plast Esthet. 1998 Apr;43(2):132-40.
Our large experience of shotgun injuries to the face emphasizes the need for a reappraisal of primary treatment for this poorly documented topic. The medical records of 165 patients, treated at our institution between january 1st, 1982 and december, 31st 1996 for such an injury, were reviewed. Almost all cases were exclusively self-inflicted lesions. The guns were mainly twelve-gauge and occasionally 16 or 20-gauge. Close range wounds in an heterogeneous area--soft-tissue, mandible, muscles of the tongue and floor of the mouth, oral and nasal cavities, maxilla and paranasal sinuses--caused massive damage. A topographic classification based on the soft-tissue and bone loss is reported. After initial management (including securing the airway and control of bleeding), conservative debridement of all devitalized tissues and stabilization of the fractures were performed. As soon as possible, bone and soft tissue reconstruction was undertaken using local or distant flaps. However, immediate definitive reconstructive procedures were scarcely [corrected] used and only in particular cases. We believe that a carefully planned reconstruction schedule is required to achieve satisfactory appearance and function.
我们在面部霰弹枪伤方面的丰富经验凸显了重新评估这一记录不完善主题的初级治疗方法的必要性。我们回顾了1982年1月1日至1996年12月31日期间在我们机构接受此类损伤治疗的165例患者的病历。几乎所有病例均为自残伤。枪支主要是12号霰弹枪，偶尔也有16号或20号的。近距离伤口出现在一个异质性区域——软组织、下颌骨、舌肌和口腔底部、口腔和鼻腔、上颌骨和鼻窦——造成了大面积损伤。报告了一种基于软组织和骨质缺损的地形学分类方法。在进行初步处理（包括确保气道通畅和控制出血）后，对所有失活组织进行了保守清创，并对骨折进行了固定。尽快使用局部或远处皮瓣进行骨和软组织重建。然而，立即进行确定性重建手术很少被采用，仅在特定情况下使用。我们认为，需要精心制定重建计划以实现令人满意的外观和功能。
