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題名 | Burned Face Reconstruction in Children--A Case Report=顏面燒燙傷畸形兒童之病例報告 |
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作者 | 喬浩禹; 陳天牧; 葛傳宇; 傅豐誠; 黃宗哲; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 24:2 2015.06[民104.06] |
頁次 | 頁160-167 |
分類號 | 417.6281 |
關鍵詞 | 燒燙傷; 顏面畸形; 兒童; Facial burn; Facial deformities; Children; Facial reconstruction; |
語文 | 英文(English) |
中文摘要 | 背 景:兒童燒燙傷導致之身體畸形,如組織缺損、眼瞼孿縮及疤痕增生等,重建任務是相當困難的,特別是包含頭頸部在內。目的及目標:呈現治療來自中國大陸燒燙燒的病童之嚴重顏面畸形重建的經驗。材料及方法:由祖父照顧的兩歲小男孩於八個月大時,蚊帳被床邊的蠟燭引燃起火,掉落下來導致嚴重顏面燒燙傷。顏面燒燙傷導致的畸形,包括禿頭、瞼裂狹小及小口症合併疤痕攣縮,鼻子缺損及耳廓畸形。經由跨領域合作醫療援助,根據病童的年紀及功能性優先順序,我們擬定階段性重建手術計畫,第一年重建眼周及嘴唇四周疤痕,從下臉頰施行局部轉位皮瓣以改善上嘴唇孿縮的問題;黏膜皮瓣作為嘴角疤痕攣縮鬆解;雙側鼻唇皮瓣手術合併植皮以改善上下眼瞼攣縮,第二年重建眼周疤痕,以內眥局部皮瓣及植皮手術重建。結 果:經由兩階段顏面燒燙傷重建手術,兩側嘴角及瞼裂狹小的問題獲得明顯改善。其餘顏面畸形的問題,如眼瞼孿縮及小口症仍需程度上的改善,鼻子缺損及耳廓畸形仍有待病童年紀較大之後處理。結 論:治療嚴重顏面燒燙燒兒童是非常挑戰的,傷口的照護及重建需由有足夠經驗處理燒燙傷傷口及後續重建的醫生來處理。 |
英文摘要 | Background: The tasks of reconstructing deformities consequential to pediatric burn injuries (e.g., structural deformities due to tissue loss, cicatricial contracture and scar hypertrophy) remain difficult, especially involving the head and neck. Aim and Objectives: Present our experience of treating a burned child from mainland China with severe facial deformities. Materials and Methods: A 2-year-old boy sustained severe third degree burns on his head and neck area when he was 8 months old. The deformities noted at the time of initial examination were scalp and eyebrow alopecia, blepharophimosis, microstomia with upper and lower lip contracture, and absence of the nose and the left ear. Via cross-disciplinary cooperation, the patient was brought to the Tri-Service General Hospital in Taiwan for further facial reconstruction. We made a staged treatment plan based on the patient’s age and functional priority. At the first year, we reconstructed the blepharophimosis and microstomia. We performed an interpositional skin flap mobilized from the lower cheek area on both sides for releasing the contracture of upper lip; Y-to-V mucosal commissuroplasty was incorporated to reconstruct commissural contracture. Nasolabial skin flap was designed for the lower eyelid contracture. At the second year, we performed the interpositional skin flap with split-thickness skin graft to provide scar release around the medial canthus and the eyelids. Results: After two-stage reconstruction, the severity of ectropion and microstomia are significantly ameliorated. Residual deformities such as persistent left eyelid contracture, microstomia, missing of the nose and left ear as well as the problems of left corneal scarring are left for further reconstruction at an older age. Conclusion: The treatment of severe facial burn deformity in children is challenging. The care should be addressed comprehensively by those who have sufficient experience in managing burn injuries and burn deformity reconstructions. |
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