运用整形技术及原则美容性修复鼻外伤(1)
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[摘要]目的：观察美容整形技术在鼻外伤修复治疗中的应用效果。方法：在107例鼻外伤患者的整个修复治疗过程中，均按照专业操作规程要求，严格应用美容整形技术进行鼻外伤的修复治疗。术后对患者进行随访观察，针对愈合过程中出现的相关问题进行相应的后期处理，以达到最佳修复效果。结果：所有患者一期修复效果均满意。对62例进行了0.5～3.5年的随访观察，其中3例进行了二次修复手术，61例远期效果满意(98.4%)。结论：美容整形技术是修复鼻外伤的有效方法，值得推广。
[关键词]鼻外伤；修复技巧；美容整形技术；远期效果
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)07-1043-03
Aesthetic repair of nose trauma with plastic skills and principles
XIAO Tiao-li1,2,TIAN Dao-fa1,LIU Gang3
(1.Traditional Chinese Medicine University of Hunan,Changsha 410007,Hunan,China;2.Department of Plastic and Cosmetic, the Second People's Hospital of Hunan Province; 3.Department of Otolaryngology, the Second People's Hospital of Hunan Province)
Abstract:Objective To sum up the clinical experience with the repair procedures of nose trauma by use of the skills of aesthetic and plastics based on a clinical trial.MethodsAesthetic and plastic principles and skills were used to repair nose trauma among 107 cases in their entire repairing course on the basis of professional level in this field. Then, these patients were followed up for 0.5 to 3.5 years to give corresponding treatment procedures for followed sequence in case of necessary to obtain the most ideal outcomes.ResultsAll the 107 cases were seen with the results of stage Ⅰrepairing operation. Among the 62 patients received a following up period lasted for 0.5 to 3.5 years, 61 (98.4%) were reached at an ideal long-term effect of repairing surgery, only 3 received a secondary repairing operation.ConclusionsAesthetic and plastic skills are the effective procedures to reconstruct the normal external nose for cases with nasal trauma, and it is worthy to be promoted into clinical practice.
Key words:nose trauma; repair skills; aesthetic and plastic procedures; long-term therapeutic effect
外鼻位于面部中央，极易因外力作用而受伤。若伤后修复不佳，常因畸形愈合遗留后遗症而影响面容外貌。日益增多的鼻外伤患者强烈要求伤口修复后不留瘢痕和外鼻畸形。因此，兼顾外观美容效果和功能要求的鼻外伤修复技术日益受到临床医生的重视。2007年1月～2010年7月，我们应用美容整形技术修复鼻外伤患者107例，取得良好效果，现总结如下。
1临床资料
1.1 一般资料：本组患者共计107例，其中男性52例，女性55例；年龄5月～72岁，中位年龄12岁，其中5月～12岁患者55例，占51.4%。所有患者均为外鼻皮肤破裂伤，部分患者合并鼻骨或鼻软骨骨折。致伤原因包括跌碰伤76例，切割伤10例，玻璃划伤7例，挫擦伤8例，拳击伤4例，咬伤2例。107例患者中，15例合并鼻骨骨折，12例合并大翼软骨或(和)鼻中隔软骨断裂，2例合并内眦韧带断裂和鼻泪管断裂，2例鼻外伤严重，外鼻接近离断。
1.2 处理方法：接诊患者后，综合判断其伤情及合并症的情况，进行必要的检查，如鼻骨等骨折需行CT三维重建等，然后进行鼻外伤的相关处理。按损伤程度不同，我们将鼻外伤分为3类进行处理。
1.2.1 单纯鼻部皮肤软组织挫裂伤：此类鼻外伤患者均在门诊手术室局麻下进行手术。先用生理盐水洗净伤口周围污物、血块，然后络合碘消毒、铺无菌巾单，沿创口边缘正常皮肤进针，注射含肾上腺素(1:20万单位)的0.5%～0.75%利多卡因溶液；麻醉成功后，用3%过氧化氢、0.9%氯化钠溶液清洗创口污物、血迹至干净。清理伤口时，务必将异物彻底清除，伤口皮肤等组织有坏死者(坏死皮肤一般成暗灰色或黑色，失去弹性)，应将其去除；边缘不整齐者，应仔细修整。彻底止血后，按美容整形手术原则，准确而又严密地分层对合，6-0～7-0美容线间断缝合，尽量将伤口张力分散至真皮层以下，使表皮层实现无张力缝合 ......
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