Bonan C, Taha F, Testelin S, Devauchelle B
Service de Chirurgie Maxillo-Faciale et Stomatologie, Centre Hospitalier Universitaire, Amiens, France.
Ann Chir Plast Esthet. 1998 Apr;43(2):149-61.
The use of free flaps to fill and repair facial defects due to suicidal gunshot wounds has considerably extended and refined the possibilities available to reconstructive surgeon. The objective is no longer to close the defect at any cost, or "fill a hole", but to replace missing tissue by an identical tissue, able to restore an identical cosmetic appearance, support equivalent constraints, and restore analogous function. Retrospective analysis of 56 cases of large facial defects due to gunshot wounds revealed a total of 66 free flaps for 32 cases. The vascular quality of the flaps allowed better integration in a sometimes hostile recipient site and markedly reduced the treatment time. Although the objective results obtained in the treatment of these severe defects remain poor, the first-line use of these multiple flaps, exclusively reserved for deep repair, as the basis for reconstruction, has modified our behaviour. A real medium-term treatment strategy, based on a decision flow-chart, can be proposed which, despite several inevitable failures, leaves less room for improvisation and piecemeal surgery. Free flaps are only the hidden part of the reconstruction, as surface cover uses local flaps and other conventional reconstructive surgery techniques. However, this humble, hidden role is nevertheless fundamental, in the strict sense of the term, and guides the general approach to this surgery.
使用游离皮瓣填充和修复自杀性枪伤导致的面部缺损，极大地扩展并完善了重建外科医生的可用方法。目标不再是以任何代价闭合缺损或“填补空洞”，而是用相同的组织替代缺失的组织，使其能够恢复相同的外观、承受相同的压力并恢复类似的功能。对56例枪伤导致的大型面部缺损病例进行回顾性分析发现，32例患者共使用了66个游离皮瓣。皮瓣的血管质量使其能更好地融入有时并不友善的受区，显著缩短了治疗时间。尽管治疗这些严重缺损所取得的客观效果仍然不佳，但将这些仅用于深部修复的多个皮瓣作为重建基础的一线应用，改变了我们的治疗方式。可以提出一种基于决策流程图的切实可行的中期治疗策略，尽管不可避免会有一些失败，但能减少即兴和零碎手术的空间。游离皮瓣只是重建的隐藏部分，因为表面覆盖采用局部皮瓣和其他传统重建手术技术。然而，从严格意义上讲，这种不起眼的隐藏作用却是根本性的，并指导着该手术的总体方法。
