儿童颌面部犬咬伤美容外科修复.docVIP

儿童颌面部犬咬伤美容外科修复[摘要]目的:探讨美容外科原则在儿童颌面部犬咬伤临床处理中的应用。方法:回顾性总结并分析2005年3月～2008年3月烧伤与修复重建外科对21例儿童颌面部犬咬伤伤口早期清创处理及整复手术治疗的临床资料。结果:所有病例均未发生狂犬病。伤口Ⅰ期II/甲级愈合19例;II期愈合2例。Ⅰ期愈合病例,伤口瘢痕达到良好的整复效果。结论:在儿童颌面部犬咬伤伤口早期处理过程中应用美容外科原则进行整复是安全可行的。 [关键词]儿童;犬咬伤;颌面部;美容外科原则 [中图分类号]R782.4 [文献标识码]A [文章编号]1008-6455(2010)01-0043-03 Cosmetic repair of maxillofacial dog bite injury in children KONG Xiao,CUI Zheng-jun,LI Guang-shuai,ZOU Shi-bo (Department of Burns and Restoration and Reconstruction Surgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,Henan,China) Abstract:ObjectiveTo investigate application of cosmetic surgery principle in clinical treatment of dog bites injury on maxillofacial area in children. MethodsAnalyze the clinical data of 21 cases of maxillofacial region dog bite injury in early debridement and reconstructive surgery,which were collected from the department of Burns and restoration and reconstruction surgery from March 2005 to March 2008 retrospectively.ResultsNo cases was suffered from hydrophobia.19 cases had the primary healing and the operations result in satisfactory plastic effect.2 cases had delayed healing.ConclusionIt is safe and feasible to repair early debridement of dog bites injury with principle of cosmetic surgery on maxillofacial area inchildren. Key words:children;dog bite;maxillofacial region;principle of cosmetic surgery 由于儿童缺乏安全意识、喜与宠物接近等原因,致使大部分犬咬伤发生于儿童,且多发生在颌面部。综合考虑颌面部伤口和狂犬病各自的特点,除了应用免疫治疗外,早期、及时、正确地处理伤口就显的尤为重要。我科于2005年3月～2008年3月共收治21例被犬咬伤颌面部的儿童,在对创面清创并免疫治疗的基础上,我们特别注重应用美容外科原则Ⅰ期修复创面,经随访,该法的运用减轻了术后颌面部瘢痕和畸形的发生,且无一例发生狂犬病。现报道如下。 1资料和方法 1.1 一般资料:本组21例患儿(男13例,女8例),年龄1岁3个月～11岁。其中颧区8例,颊区6例,唇区5例,眶区及眶下区4例,鼻区3例,腮腺咬肌区3例,颏区2例,耳区1例。损伤程度:颧、颊、耳、唇及眼睑部分撕脱12例;颊部贯通伤3例;软组织缺损4例,其中颧区2例,唇区1例,颊区1例。缺损范围:1cm×2cm者1例(上唇部),2cm×2cm～2cm×4cm者3例(颧区和颊区)。本组资料中无大面积软组织缺损及骨骼受损病例,就诊时间8h内13例,8～24h为6例,24h以上为2例。其中,最早就诊时问为30min,最迟就诊时间60h。 1.2 治疗方法 1.2.1伤口清创:儿童被犬咬伤后,情绪多惊恐不安,且伤口剧痛,致使其不配合检查及治疗,所以,给予气管插管麻醉用于创面的清创及整复。用20%无菌肥皂水、生理盐水依次冲洗周围皮肤及伤口3遍,并挤压伤口处周围皮