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題名 | Saving an Open Frontobasal Fracture with Brain Herniation by Urgent Microsurgical Free Flap Transfer=緊急顯微游離肌瓣轉移手術挽救開放性前額顱底骨折合併腦疝脫 |
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作者 | 呂炯毅; 林承弘; 潘俊豪; 陳建宗; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 22:4 2013.12[民102.12] |
頁次 | 頁344-350 |
分類號 | 416.413 |
關鍵詞 | 前額顱底骨折; 腦疝脫; 游離肌瓣; Frontobasal fracture; Free flap; Cerebrospinal fluid; |
語文 | 英文(English) |
中文摘要 | 背景:開放性前額顱底骨折常發生於高度能量撞擊外傷後,因而導致顏面骨架構損失、顱內出血、腦損傷及中樞神經系統感染的可能性。目的及目標:當遇到嚴重的顱顏骨折合併硬腦膜缺損及腦組織疝脫時,緊急顯微重建手術是可以救命。材料及方法:一位39歲男性遭遇鐵鎚撞擊前額頭部,因而造成粉碎性開放性前額顱底骨折,併有顱內出血、腦水腫及腦髓液外漏。這病患之後接受了雙側前額骨減壓移除手術,但術中發現顱底骨及硬腦膜缺損,而腦組織有疝脫到鼻腔內。結果:此病患的重建採用游離股外側肌瓣來添補硬腦膜缺損的部分及阻隔前額顱底骨及鼻腔之前的相通,因而避免持續性的腦髓液外漏及中樞神經系統感染。術後病患有順利復原而再也未發現任何腦髓液外漏。六個月後病患有接受階段性顱骨成形重建手術來恢復前額骨及顏面的輪廓。結論:此游離股外側肌瓣的功能主要是(1)阻隔腦髓液外漏及(2)預防來至鼻腔造成中樞神經系統感染。積極運用游離顯微手術來挽救急性開放性前額顱底骨折及挽留病患生命是一個很好的選擇。 |
英文摘要 | Background:Open frontobasal fractures resulting from high energy traumatic contusions may lead to loss of facial bony structure, intracranial hemorrhage, brain damage, and possible subsequent central nervous system infection.Aim and Objectives:In a case of severe craniofacial injury accompanied with skull base fracture and dura defect with brain herniation, early reconstructive procedure is required to save the patient's life.Materials and Methods:A 39 years old male suffered from traumatic contusions to the head and frontal region by a hammer which resulted in a comminuted open frontobasal bone fracture accompanied with intracranial hemorrhage, severe brain swelling, and cerebrospinal fluid (CSF) leakage. Bifrontal craniectomy with removal of bone fragments was performed to relieve the intracranial pressure. However, brain herniation with a large dura defect was found at the skull base, which allowed the brain tissue to herniate into the nasal cavity.Results:Urgent free vastus lateralis muscle flap was harvested to plug the skull base and act as a waterproof barrier between the anterior cranial fossa and the nasal cavity, thus preventing further CSF leakage and ascending infection into the brain. The postoperative course was smooth and the flap was well vascularized with no further CSF leakage. Staged cranioplasty was performed to restore craniofacial contour 6 months later.Conclusion:The free vascularied muscle flap acted as a waterproof barrier to prevent CSF leakage and ascending infection from the nasal cavity. It was a valuable option in saving a patient's life with a lethal injury. |
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