Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries

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• 作者：Peng Sen Wu^a ; Reshvin Matoo^a ; Hong Sun^a ; Li Yuan Song^a ; Don O. Kikkawa^b ; Wei Lu^a ; ^{drluweicn@163.com}
• 关键词：Open orbital fractures ; Orbital reconstruction ; Stony Brook Scar Evaluation Scale
• 刊名：Journal of Plastic, Reconstructive & Aesthetic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：70
• 期：2
• 页码：e1-e6
• 全文大小：637 K
• 卷排序：70

文摘

Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries.MethodsRetrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48 h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months.ResultsThe main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30–0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05–3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection.ConclusionsAn early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity.