自我造成的枪伤后面部重建:预测因素、并发症和可接受的结果

Patrick A. Palines, Sarah Y. Park, Rory J. Loo, Jason R. Siebert, B. Grunert, S. Pawar, J. LoGiudice, R. Havlik, P. Hettinger
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引用次数: 0

摘要

背景:自我造成的枪伤(SIGSWs)会产生破坏性的面部缺陷,具有挑战性的重建,但在文献中很少有大的队列报道。本研究试图确定这些损伤的特征,并确定影响面部重建幸存者并发症和结果的参数。方法:对2009年至2019年在本中心进行面部重建的22例SIGSWs患者进行回顾性队列研究。回顾了患者、损伤和重建的细节和过程。结果与各参数进行统计学比较。结果:最常见的枪械、体位和损伤部位分别为手枪(40.9%)、颏下(59.1%)和下颌骨(68.2%)。患者平均住院时间为21.7天,清创时间为17.4小时,骨固定时间为2.6天,5.4例重建手术,7例(31.8%)患者接受了至少一个游离皮瓣。15例(68.2%)患者至少有一种主要并发症,尽管最终的功能结局总体上相对较好。值得注意的结果关联包括颏下取向与较长的LOS (p = 0.027),外固定物与较长的LOS (p = 0.014),财务压力与较短的LOS (p = 0.031),严重软组织损伤与重建手术总数增加(p = 0.039)和不完全重建(p = 0.031)。没有自杀式再犯的案例。结论:面部SIGSW术后的重建对患者和外科医生都具有挑战性,且并发症发生率高。然而,患者可以在重建后恢复基本功能并取得满意的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Facial Reconstruction Following Self-Inflicted Gunshot Wounds: Predictors, Complications, and Acceptable Outcomes
Background: Self-inflicted gunshot wounds (SIGSWs) produce devastating facial defects that are challenging to reconstruct, but are rarely reported in large cohorts in the literature. This study sought to characterize these injuries, and identify parameters influencing complications and outcomes among survivors following facial reconstruction. Methods: A retrospective cohort study was performed identifying 22 patients with SIGSWs to the face reconstructed at our center from 2009 to 2019. Charts were reviewed for patient, injury, and reconstructive details and course. Outcomes were statistically compared to various parameters. Results: The most common firearm, orientation, and injured structure were the handgun (40.9%), submental (59.1%), and mandible (68.2%), respectively. Patients averaged a 21.7-day length of stay (LOS), 17.4 h to debridement, 2.6 days to bony fixation, 5.4 reconstructive surgeries, and 7 (31.8%) patients received at least one free flap. Fifteen (68.2%) patients had at least one major complication, although functional outcomes were ultimately relatively good overall. Notable outcome associations included submental orientation with a longer LOS (p = 0.027), external fixation with a longer LOS (p = 0.014), financial stressors with a shorter LOS (p = 0.031), and severe soft tissue injury with an increased total number of reconstructive surgeries (p = 0.039) and incomplete reconstruction (p = 0.031). There were no cases of suicidal recidivism. Conclusions: Reconstruction following facial SIGSW is challenging for both patient and surgeon, and carries a high rate of complications. However, patients can regain substantial function following reconstruction and the achievement of satisfactory outcomes.
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