应用耳后弯曲矩形滑行推进皮瓣修复中重度耳轮皮肤缺损的术式探讨

发布时间：2018-08-08 14:14

【摘要】：目的:探讨应用耳后弯曲矩形滑行推进皮瓣修复中重度耳轮皮肤缺损的方法和应用。方法:自2015年3月至2016年7月,采集山西医科大学第一附属医院整形烧伤外科诊治的20例中重度耳轮皮肤缺损患者(耳轮皮肤缺损的原因包含各种外伤,人或动物咬伤,肿瘤等),其采用耳后弯曲矩形滑行推进皮瓣的方法进行修复,一期行耳轮缺损区清创准备/肿物切除—残端耳后埋植术,6周后二期行耳轮断蒂成形术,耳后供瓣区应用乳突区弯曲矩形滑行推进皮瓣进行修复。所有手术均由同一位主刀医生完成,术后随访观察时间为6-15个月。采用直接观察法,POSAS量表,评价应用耳后弯曲矩形滑行推进皮瓣修复中重度耳轮皮肤缺损的术后效果。计量资料用均数±标准差()表示,计数资料用百分数表示,患者与观察者之间对术后效果的满意度用卡方检验。全部资料用SPSS17.0for windows统计。检验水准α=0.05。3.研究结果(1)直接观察法:本课题20例患者无一出现感染、伤口哆开,断蒂及滑行推进皮瓣均成活良好,其中18例患者患侧耳外形良好,轮廓流畅,厚度、色泽等与周围皮肤相似,耳后乳突区瘢痕增生不明显,接口处无明显凹凸感;其中1例患者术后患侧耳略显臃肿,线条不够流畅,且色泽较周围皮肤较深;1例患者耳后耳轮及乳突区瘢痕增生比较明显。sx±(2)POSAS量表结果:患者术后满意度达85%,观察者满意度达90%,且患者与观察者满意度评估差别无统计学意义。结论:应用耳后弯曲矩形滑行推进皮瓣修复中重度耳轮皮肤缺损,具有操作简单,术后外观良好,视觉差异性小,供瓣区瘢痕隐蔽,值得临床推广应用。
[Abstract]:Objective: to explore the method and application of retroauricular curved rectangular sliding flap for repairing moderate and severe ear wheel skin defect. Methods: from March 2015 to July 2016, 20 patients with moderate and severe earwheel skin defects were collected and treated in plastic surgery and burn surgery, first affiliated Hospital of Shanxi Medical University. (tumor, etc.), it was repaired by curved rectangular propelling flap behind the ear, debridement preparation / mass excision of ear ring defect area in one stage and pedicle reconstruction of ear wheel broken in the second stage after 6 weeks of stump ear implantation. The posterior ear donor flap was repaired with papillary rectangular sliding flap. All operations were performed by the same surgeon and followed up for 6-15 months. POSAS scale was used to evaluate the effect of retroauricular curved rectangular sliding flap for repairing severe earwheel skin defect. The measurement data were expressed as mean 卤standard deviation, the counting data were expressed as percentage, and the satisfaction between the patient and the observer was measured by chi-square test. All data were counted by SPSS17.0for windows. The test level is 0.05.3. Results (1) Direct observation: no infection was found in the 20 patients, the wound was reopened, the pedicle was broken and the gliding flap survived well. Among them, 18 cases had good shape, smooth contour and thickness of the affected lateral ear. The color and luster were similar to those of the surrounding skin, the scar hyperplasia in the posterior mastoid area was not obvious, and there was no obvious concave and convex sensation in the junction. In one case, the lateral ear was slightly bloated and the lines were not smooth enough after operation. The results of sx 卤(2) POSAS scale showed that the patients' satisfaction after operation was 85 and the observer's satisfaction was 90. There was no significant difference between the patient and the observer. Conclusion: the reconstruction of moderate and severe earwheel skin defect with rectangular sliding-forward flap behind the ear is simple, the appearance is good, the visual difference is small, the scar of donor flap area is concealed, and it is worth popularizing and applying in clinic.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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