- 期刊
Microsurgical Mini-Sized Lip Replantation-A Case Report and Literature Review
顯微手術小體積下唇再植－病例報告及文獻回顧
摘要
背景：下唇在植在文獻上很少相關經驗提出。如何回復唇部的功能及外觀是創傷後的一大挑戰。目的及目標：我們提出針對小體積的下唇因狗咬傷的撕裂，以單一唇動脈合併靜脈轉接做在植手術。術後靜脈給予抗凝血劑點滴滴注，以此設法維持皮瓣的靜脈回流。以此方法能夠重建令人滿意的唇部外觀及功能。材料及方法：我們報告一位48歲的女性患者，其下唇中央因狗咬傷造成一個2公分x3公分x2公分的缺陷。撕裂的下唇組織帶來急診後我們將其保存在低溫環境下。緊急下唇再植顯微手術隨即進行。我們以左側下唇動脈合併靜脈轉接作單一動脈血管來源。靜脈回流部分由於撕裂傷影響的範圍太大無法找到合適的靜脈重接故以靜脈滴注抗凝血劑來維持皮瓣靜脈回流，在四到六天後血管新生過程完成後再慢慢將滴注的藥物停掉。病人在手術後一周將鼻胃管移除由口正常進食，並且在術後十天出院。病人出院後定期在門診追蹤，並且在每次門診都針對病灶部位拍照記錄，作為臨床評估治療效果的依據。結果：病人術後住院康復時間很短，唇部的外型柔軟度顏色及功能和感覺回復都令人滿意，但因病人有蟹足腫體質故在取靜脈的左手前臂及在植組織的周圍有些許的疤痕增生。手術後追蹤三個月的期間病人相當滿意。結論：以單一動脈合併靜脈轉接的顯微手術，對於較小體積的下唇顯微手術再植是一個最有效並且提供令病人相當滿意的復原效果，在外觀及功能的修復都相當快速。
關鍵字
無資料並列摘要
Background: Avulsion injury of lip is a rare condition and is challenge to restore both of the functional and aesthetic outcome. Aim and Objectives: Specifically, for minimal segment of lower lip amputation, we proposed a successful case that replantation was carried out by only one arterial revascularization with an interposition of vein graft which is an effective and reliable method to restore both the functional and aesthetic outcome. Materials and Methods: We present a 48-year-old female patient with a traumatic avulsion injury of partial lower lip, resulting from a dog bite. A small piece of the lower lip, consisting of the vermillion and both of the mucosal and myocutaneous flap was brought. We performed an emergent replantation with vein grafts harvested from left forearm. Post-operative anticoagulants and antibiotics were used for one week. After discharged from the hospital, we followed up this patient regularly in the out-patient clinic. Serial photographs of lesion site were taken during each out-patient visit as part of our clinical assessment and documentation. Results: After the surgery, the replanted tissue turn congested initially and resolved after medication. Crusting coverage was removed gradually in our out-patient clinic. The results of aesthetic and functional outcome were satisfied in all terms of form, colour match, texture, contour and the sensitivity. However, hypertrophic scar of the replanted tissue and the suture line over the forearm was noted and still under observation at our out-patients clinic. Conclusion: We demonstrated that replantation carried out by only one arterial revascularization with an interposition of a vein graft is an effective and reliable way for restoration both the functional and aesthetic results of avulsed minimal segment of lower lip.
延伸閱讀
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- Chen, C. H., Chen, C. C., Chien, H. F., & Cheng, N. C. (2015). 合併鼻唇溝皮瓣和Z形整形術矯正牙關緊閉併嘴角重建－兩病例報告及文獻回顧. 臺灣整形外科醫學會雜誌, 24(1), 69-76. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201503-201504140013-201504140013-69-76
- 張瑞忠、曾春祺、彭玉秋（2010）。鼻竇增高術在覆蓋性全口義齒植牙的應用：病例報告與文獻回顧。臺灣牙周病醫學會雜誌，15(1)，1-9。https://www.airitilibrary.com/Article/Detail?DocID=10279962-201003-201010270094-201010270094-1-9
- 楊方瑜、郭生興、李正喆（2009）。以單側或雙側鼻唇皮瓣重建下唇全層缺損－二病例報告。臺灣口腔顎面外科學會雜誌，20(4)，256-262。https://doi.org/10.7104/TJOMS.200912.0256