Brain contusion and laceration

In closed head injury, contusion and laceration of brain parenchyma caused by impact injury and impact injury, and brain swelling and cerebral edema secondary to injury are often the main causes of death in severe head injury. To this end, in the past, people have used various forms of skull decompression and decompression, such as bilateral frontal bone resection, and partial cranial bone resection, which has been proven to be ineffective and has been abandoned. However, the lesions of large inactivated brain tissue caused by brain contusion and laceration should be treated with the same hematoma. Some patients can control the development of cerebral edema only after removing large inactivated brain lesions. Brain lesions can occur at the point of impact and can also occur at the heel site, but most occur with the frontal and frontal, bungee and sacral bases of the hedging site. Even if there is no hematoma, only a wide range of brain contusion and laceration, and those with serious injuries need surgery, in order to save more patients' lives. Treatment of diseases: closed head injury Indication 1. There was no obvious intracranial hematoma in the CT scan, but at the impact point, especially the CT scan showed a mixed density of the brain contusion and laceration of the frontal and temporal surfaces of the frontal lobe of the hedging site, surrounded by a wide range of brains. Edema, accompanied by a placeholder effect, the injury continues to worsen. 2. Patients with occipital force have ruled out intracranial hematoma, but the disturbance of consciousness does not improve, and the brain pressure continues to increase, conservative treatment is ineffective, and eventually there is a cerebral palsy. 3. The pupils have been scattered, the symptoms of cerebral palsy are obvious, no hematoma is found in many drills, and those with severe brain contusions are found in the drilled holes. Contraindications 1. Being too old and having severe systemic diseases. 2. The condition is already in the state of sudden death in the late stage of cerebral palsy. Preoperative preparation Prepare for emergency surgery, in the race against time: 1. Learn more about the causes of injury, the head of the head, the change of consciousness after injury, the time of pupil dilation, and the examination of vital signs, especially the situation of breathing and blood pressure. 2. Immediately shave all the hair, check the scalp injury site, and disinfect the iodine and ethanol to wrap the sterile towel. 3. The blood collection and blood supply pool is matched with blood. 4. Intravenous drops of 20% mannitol 200 ~ 400ml. 5. If the respiratory dysfunction is obvious, the trachea can be intubated and sucked before the operation, and artificial assisted breathing can be given. Surgical procedure Incision Different incisions were taken according to the location of the brain injury. 2. Drilling exploration Patients who have not undergone CT examination should first be drilled in the lower ankle or frontal pole. A thin layer of hematoma is common under the dura mater, and when it is removed, the swollen brain tissue bulges outward. Brain contusion is in the vicinity. Probing to the bottom of the brain often confirms the presence of the lesion. 3. Bone craniotomy After the diagnosis was confirmed by CT or borehole exploration, the craniotomy was performed. The dura is turned to the midline or the other side. 4. Clear inactivated brain tissue In the pia mater of the brain injury, it is often purple-red, and some small blood clots and broken, necrotic, softened brain tissue are visible on the surface. The aspirator is used to start the aspiration from the insulted lesion, and the blood vessel is subjected to electrocoagulation. So gradually cleared, the brain gradually softened and collapsed. If it is a hedging injury, it is necessary to use the brain pressure plate to lift the frontal and temporal lobes, and completely remove the inactivated tissue from the brain surface. When removing the wound, it can start on the surface of the brain and gradually clear to the deep part, so that the cleared brain area is wedge-shaped or pot-shaped. The standard for complete elimination is that the brain becomes soft, sag, and resumes pulsation. If the brain pressure is still high and the brain is swollen, internal decompression of the frontal and/or bungee resection can be used. 5. Wound hemostasis This type of surgery often has a wide range of oozing in the postoperative wounds. It can be stopped by electrocoagulation, gauze with hydrogen peroxide or gelatin sponge. To stop bleeding completely. 6. Guan skull After the brain contusion is removed, if the area is not swollen, the dural can be sutured, but it is often necessary to perform subcondylar decompression. For patients with severe cerebral edema, decompressive craniectomy or even bilateral decompression is required. The scalp is layered and sutured. complication In addition to the common complication that often occurs after craniotomy, special attention should be paid to: 1. Postoperative recurrent hematoma and delayed hematoma. It should be discovered and disposed of in time. 2. Secondary brain swelling and cerebral edema should be properly controlled. 3. Long-term coma patients are prone to pulmonary infection, water and electrolyte balance disorders, hypothalamic dysfunction and malnutrition, etc., should be treated accordingly.

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