Simplest Roundblock Maneuvers for Reconstructing Recalcitrant Facial Traumatized Defects: A Case Report

簡單圓筒式縫合術對困難性顏面外傷傷口之重建應用：病例報告

李國忠(Kuo-Chung Lee) ； 林鴻儒(Hung-Ru Lin) ； 李志源(Chih-Yuan Lee)

《南臺灣醫學雜誌》 5卷2期 (2009/12) Pp. 82-88

https://doi.org/10.6726/MJST.200912_5(2).0005

摘要

圓筒式術法係改良之真皮層袋線式縫合技巧，最早被應用於皮膚手術者是在縮乳手術，以期減少疤痕長度及促進美容效果；至於軟組織傷害之修補重建，不論簡單抑或複雜如果想要得到絕佳之美觀效果，最重要的技巧重點就是將真皮層正確有效的對齊並將過度之張力引導致皮膚深層。自2005年1月至2008年12月，我們對7位（6男、1女）轉診的困難性顏面外傷傷口患者，年齡自17到82歲，使用改良的袋線式縫合手術式取代複雜之皮瓣手術重建困難的顏面軟組織缺陷。在保留原有相關解剖方位的立意下，除施行傷口緣清創術外，極少行術中擴底式撥動組織，隨即就快速經濟的用2-0以上之大口徑尼龍線直接自真皮層以袋線逢合法直接包夾關閉傷口缺損，在局部麻醉下，往往15分鐘內就能關閉一處困難傷口缺損。更省略複雜的皮瓣設計思考，以求速戰速決就能一氣呵成完成重建，關閉傷口。術後至少靜候6週再將這駐留縫線移除。儘管初期會對五官造成扭曲變形，但最終都得到相當令人滿意的功能與美觀上之治療成效。此一改良縫合手術不僅相當簡易快速、經濟有效、安全，更值得在急性軟組織缺損傷口的重建上，提供另類術式選擇的思考，尤其對顏面傷口重建之美觀考量上也提供了另類好的方向、經驗。

關鍵字

圓筒式術法 ； 真皮袋線式縫合 ； 顏面外傷

並列摘要

Roundblock technique was a modified dermal pursestring sutures, firstly, applied in Cutaneous surgery, like reduction mammaplasty to reduce scar dimensions. For repairing the softest tissue injury, whether simple or complicated, direct closure of a full-thickness defect by excellent approximation of the deep dermal layer and place the tension of closure deep to the skin is the most important keystone to attain the best aesthetic result. From 2005 January to 2008 December, seven recalcitrant facial traumatized defects (6 males,1 female, range from 17-82 y/o) affecting prominent facial landmarks, which attracted people's attention like breast figures, and entangled for regular repair, were referred and enrolled with modified application of this old sutures, deep dermal pursestring suture with 2-o or 1-0 nylon. Little or no undermining was taken intraoperatively and staying stitches were removed 6 weeks later at least. Most procedures were instituted under local infiltration and finished within 15 minutes. All got greatly cosmetic and functional results despite early distorting effects. We designed and recommended this old-fashioned suture modification applied in some urgently extreme cases of soft tissue injury. It is simple, economic, rapid, safe, and effective, especially in the field of reconstructing the cosmetic-oriented facial trauma.

並列關鍵字

roundblock ； dermal pursestring suture ； facial trauma