颌面部弹道伤中的微血管重建。

文献信息

中文摘要

背景： 颌面部弹道伤因解剖结构复杂且需同时恢复美观及言语、吞咽等基本功能，构成重大的重建挑战。本研究评估此类损伤中的微血管重建策略及相关并发症。
方法： 开展了一项回顾性描述性研究，纳入在一家Ⅰ级创伤中心接受治疗的患者，时间跨度为10年。纳入标准为：（1）下面部或中面部弹道伤；（2）组织缺损需行微血管重建；（3）临床及影像学资料完整。收集的数据包括人口学资料、损伤特征、重建技术、并发症及微生物学检查结果。
结果： 2015年至2025年间共有9例患者接受微血管重建，共实施15例游离皮瓣手术，其中10例为腓骨游离皮瓣。1例皮瓣因术后3个月感染而失败。7例为延期重建。战争相关损伤及延期重建与术前伤口感染及多重耐药革兰阴性（MDRGN）菌检出显著相关（分别为P = 0.018和P = 0.023）。MDRGN菌的存在与手术部位感染的发生显著相关（P = 0.016）。
结论： 即使在不利条件下，微血管游离皮瓣重建仍是复杂颌面部弹道伤的金标准。战争相关创伤及延期重建与感染性并发症（尤其是涉及MDRGN者）密切相关，围手术期管理应予以充分考虑。

英文摘要

BACKGROUND: Ballistic injuries to the maxillofacial region pose a major reconstructive challenge due to complex anatomy and the need to restore both aesthetic appearance and essential functions such as speech and swallowing. This study evaluates microvascular reconstruction strategies and associated complications in these injuries.
METHODS: A retrospective descriptive study was performed, including patients treated at a level I trauma center during a 10-year period. Inclusion criteria were (1) ballistic injury to the lower face or midface, (2) tissue loss requiring microvascular reconstruction, and (3) complete clinical and radiological documentation. Data collected included demographics, injury characteristics, reconstructive techniques, complications, and microbiological findings.
RESULTS: Nine patients underwent microvascular reconstruction between 2015 and 2025, with a total of 15 free flap procedures performed, including 10 fibula free flaps. One flap loss occurred due to infection 3 months postoperatively. Reconstruction was delayed in 7 cases. War-related injuries and delayed reconstruction were significantly associated with preoperative wound infection and detection of multidrug-resistant Gram-negative (MDRGN) organisms (P = 0.018 and P = 0.023, respectively). The presence of MDRGN organisms was significantly associated with the occurrence of surgical site infections (P = 0.016).
CONCLUSIONS: Microvascular free flap reconstruction remains the gold standard for complex maxillofacial ballistic injuries, even under adverse conditions. War-related trauma and delayed reconstruction are strongly associated with infectious complications, particularly involving MDRGN, and should be carefully considered in perioperative management.