장기간의 보존적 배농술로 치료된 하악 복합골절 관련 광범위 골수염 치험
The long-term conservative drainage care of extensive osteomyelitis associated with mandibular compound fracture
김하랑, 유재하, 모동엽, 최병호, 이천의, 설성한,
소속 상세정보
김하랑 ( Kim Ha-Rang ) - 연세대학교 치과대학 구강악안면외과학교실
유재하 ( Yoo Jae-Ha ) - 연세대학교 치과대학 구강악안면외과학교실
모동엽 ( Mo Dong-Yub ) - 연세대학교 치과대학 구강악안면외과학교실
최병호 ( Choi Byung-Ho ) - 연세대학교 치과대학 구강악안면외과학교실
이천의 ( Lee Chun-Ui ) - 연세대학교 치과대학 구강악안면외과학교실
설성한 ( Sul Sung-Han ) - 연세대학교 치과대학 구강악안면외과학교실
KMID : 0360120090310060544
Abstract
Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires&plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.
키워드
Fracture osteomyelitis;Post-operative infected wound;Long-term conservative drainage
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