皮肤扩张法外耳再造二期术后软骨支架外露的处理

发布时间：2018-04-13 19:34

本文选题：小耳畸形 + 外耳再造　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:外耳再造是整形外科中最具有挑战的手术之一。及时、正确地处理其并发症,对手术效果具有重要意义。肋软骨支架移植后皮肤破溃是外耳再造术后常见的并发症之一,处理不当可能会导致软骨支架外露甚至感染而取出肋软骨支架。本研究旨在总结外耳再造手术后14个月内发生术后皮肤破溃的病例,以期为临床提供参考。方法:选取中国医学科学院整形外科医院整形七科从2016年1月1日-2017年2月28日就诊于我科行皮肤扩张法外耳再造2期手术的患者共367人,374耳。其中男260人,女107人,左耳123,右耳237,双耳7。年龄5-37岁,平均年龄10.6岁。从中选择出现皮肤破溃导致软骨支架外露而需入院手术干预治疗的患者。结果:发生术后再造耳软骨支架外露的而需入院手术治疗的患者需入院手术治疗3例,发生率为0.82%,其中一例接受局部筋膜瓣转移+游离植皮,一例接受颞浅筋膜瓣(以颞浅动脉为蒂)合并皮片移植法修复,一例清创后缝合。修复后,平均术后随访三个月,伤口甲级愈合,未出现皮肤破溃及软骨支架外露,软骨支架亦未变形、吸收。结论:再造耳皮肤破溃后,经清创后行颞浅筋膜瓣(以颞浅动脉为蒂)+皮片移植,局部筋膜瓣+游离植皮修复,或直接清创缝合;根据软骨支架外露程度选择修复方法,预后良好。
[Abstract]:Objective: ear reconstruction is one of the most challenging operations in plastic surgery.Timely and correct management of complications is of great significance to the effect of operation.Skin rupture after costal cartilage stent transplantation is one of the common complications after external ear reconstruction. Improper treatment may lead to cartilage stent exposure or even infection and the removal of costal cartilage scaffold.The purpose of this study was to summarize the postoperative cases of skin rupture within 14 months after external ear reconstruction, and to provide reference for clinical practice.Methods: 367 patients (374 ears) from January 1, 2016 to February 28, 2017 in plastic surgery Department of Chinese Academy of Medical Sciences were selected.Male 260, female 107, left ear 123, right ear 237, double ear 7.The average age was 10.6 years.Select patients whose skin burst and chondrogenic stents are exposed and require surgical intervention.Results: three patients with postoperative exposure of reconstructed auricular cartilage stent were admitted to hospital for surgical treatment, the incidence rate was 0.820.One of them received free skin graft with local fascia flap metastasis.One case received superficial temporal fascia flap (pedicled with superficial temporal artery) combined with skin graft, and one case was sutured after debridement.After the repair, the average follow-up was 3 months, the wound healed in grade A, no skin burst, cartilage stent exposed, cartilage scaffold did not deform and absorb.Conclusion: after debridement, skin graft of superficial temporal fascia flap (pedicled with superficial temporal artery), free skin graft of local fascia flap, or direct debridement and suture are performed after debridement, and the repair method is chosen according to the degree of exposure of cartilage stent.The prognosis is good.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9;R622

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