皮肤软组织扩张技术应用于耳廓再造的临床研究
发布时间：2018-08-08 12:17
【摘要】：目的：研究皮肤软组织扩张技术在耳廓再造中的临床应用,并对手术效果进行评价和讨论,以期为耳廓缺损患者提供更优化的治疗方法。 方法：自2011年8月至2014年1月,共计544例耳廓缺损患者接受扩张法耳廓再造术。根据患者乳突区皮肤软组织条件以及患者及其家属的意愿,459例患者接受“扩张两瓣法”耳廓再造术,85例患者接受“扩张单瓣法”耳廓再造术。两种方法的手术步骤均分三期完成：一期耳后扩张器置入术。二期肋软骨采取,耳支架雕刻,扩张器取出,耳支架包裹。三期再造耳修整,耳屏再造,耳垂转位,耳甲腔加深。两种方法的不同之处在于,二期手术时“扩张两瓣法”耳廓再造术需利用耳后扩张皮瓣联合耳后筋膜瓣加皮片移植包裹耳支架,而“扩张单瓣法”耳廓再造术仅单纯利用扩张皮瓣包裹耳支架。 结果：本组患者术后随访1-29个月,平均随访10个月。511例(94%)患者认为术后效果满意,再造耳愈合良好,再造耳位置、形态、大小、耳颅角与健侧基本对称,轮廓清晰、自然、稳定,无严重并发症发生;28例(5%)患者认为手术效果可以接受;5例(1%)患者对手术效果不满意。本组病例出现术后并发症44例(8%)。其中血肿6例,清除血肿后顺利扩张；头皮切开裂开1例,清创缝合后顺利扩张；扩张器渗漏7例,扩张器置换后顺利扩张；扩张器感染2例,最终取出扩张器；扩张皮瓣破裂14例,都提前进行手术；耳支架外露8例,其中4例换药保守治疗后创面愈合,1例清创后局部组织瓣覆盖,3例清创后颞顶筋膜瓣覆盖；耳支架感染4例,其中3例保守治疗后愈合,另有1例患者保守治疗无效,取出耳支架,为最严重并发症；腹部切口愈合不良1例,经换药治疗后愈合；耳后植皮成活不良3例,经换药治疗均治愈；肋软骨采取时胸膜损伤1例,术中及时发现后修复胸膜,术后无不良反应。 结论：应用皮肤软组织扩张技术,增加了耳后皮肤量、使皮肤变薄,为耳廓再造术提供了更多可用的皮肤,并使得再造耳外观及轮廓更加清晰。尤其适合于耳后皮肤筋膜紧或厚,皮肤面积小,发际线低,耳后皮肤软组织受到破坏的患者。“扩张单瓣法”耳廓再造术技术简单,创伤小,瘢痕少,如患者皮肤条件允许应尽量选择；而且,为耳后皮肤、筋膜都受到严重破坏的患者,提供了一种有效的治疗手段。我们认为,在全耳廓再造中,没有一种方法适合于所有患者,根据患者个体差异选择相应的术式,可以更充分地发挥不同技术的优势,提高再造耳的优良率。
[Abstract]:Objective: to study the clinical application of skin and soft tissue expansion technique in auricle reconstruction, and to evaluate and discuss the effect of operation in order to provide a better treatment method for auricular defect patients. Methods: from August 2011 to January 2014, 544 patients with auricle defects were treated with dilated auricle reconstruction. According to the skin and soft tissue conditions in the mastoid area and the wishes of the patients and their families, 459 patients underwent "dilated two flaps" auricle reconstruction and 85 patients underwent "expanded single flap" auricle reconstruction. The two procedures were equally divided into three stages: one-stage retroauricular dilator implantation. The second stage costal cartilage is taken, the ear bracket is carved, the expander is taken out, and the ear bracket is wrapped. Stage 3 reconstruction of ear, reconstruction of ear plate, transposition of ear lobe, deepening of ear nail cavity. The difference between the two methods is that "dilatation of two flaps" of auricle reconstruction requires the use of a retroauricular expanded flap combined with a posterior fascial flap and a skin graft to encapsulate the stent. The auricle reconstruction with dilated single flap was only used to wrap the auricular stent with expanded skin flap. Results: the patients were followed up for 1-29 months. The average follow-up was 10 months. 511 patients (94%) thought that the postoperative effect was satisfactory, the reconstructed ear healed well, the position, shape and size of the reconstructed ear, the cranial angle of the reconstructed ear were symmetrical with the healthy side, the outline was clear and natural. There were 28 cases (5%) with no serious complications and 5 cases (1%) were not satisfied with the result of operation. Postoperative complications occurred in 44 cases (8%). 6 cases of hematoma, 1 case of scalp incision and fissure, 7 cases of dilatator leakage, 2 cases of dilator infection, and 2 cases of dilator infection, and 1 case of scalp incision and debridement and suture, 7 cases of dilator leakage, 2 cases of dilator infection, and 2 cases of dilator infection. 14 cases of expanded flap ruptured, 8 cases of ear stents exposed, 4 cases of wound healing after conservative treatment, 1 case of local tissue flap covering after debridement, 3 cases of temporal fascial flap covering after debridement, 4 cases of auricular stents infection, Among them, 3 cases healed after conservative treatment, and 1 case got rid of the stents after conservative treatment, which was the most serious complication; 1 case had bad healing of abdominal incision after dressing change; 3 cases had poor survival of posterior ear skin graft. The pleural injury occurred in 1 case when the costal cartilage was taken, and it was found in time during the operation and repaired after the operation, but there was no adverse reaction after operation. Conclusion: the technique of skin soft tissue expansion can increase the amount of skin behind ear, make skin thinning, provide more useful skin for auricle reconstruction, and make the appearance and contour of reconstructed ear more clear. It is especially suitable for the patients with tight or thick fascia, small skin area, low hairline and damaged skin soft tissue. The technique of "expanding single flap" auricle reconstruction is simple, less trauma and less scar. If the skin condition of the patient is allowed, it should be chosen as far as possible. Moreover, it provides an effective treatment for the patients whose skin and fascia are seriously damaged. We believe that there is no one method suitable for all patients in total auricle reconstruction. Choosing the corresponding operation method according to the individual differences of patients can give full play to the advantages of different techniques and improve the excellent and good rate of ear reconstruction.
【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】：2014
【分类号】：R764.9
[Abstract]:Objective: to study the clinical application of skin and soft tissue expansion technique in auricle reconstruction, and to evaluate and discuss the effect of operation in order to provide a better treatment method for auricular defect patients. Methods: from August 2011 to January 2014, 544 patients with auricle defects were treated with dilated auricle reconstruction. According to the skin and soft tissue conditions in the mastoid area and the wishes of the patients and their families, 459 patients underwent "dilated two flaps" auricle reconstruction and 85 patients underwent "expanded single flap" auricle reconstruction. The two procedures were equally divided into three stages: one-stage retroauricular dilator implantation. The second stage costal cartilage is taken, the ear bracket is carved, the expander is taken out, and the ear bracket is wrapped. Stage 3 reconstruction of ear, reconstruction of ear plate, transposition of ear lobe, deepening of ear nail cavity. The difference between the two methods is that "dilatation of two flaps" of auricle reconstruction requires the use of a retroauricular expanded flap combined with a posterior fascial flap and a skin graft to encapsulate the stent. The auricle reconstruction with dilated single flap was only used to wrap the auricular stent with expanded skin flap. Results: the patients were followed up for 1-29 months. The average follow-up was 10 months. 511 patients (94%) thought that the postoperative effect was satisfactory, the reconstructed ear healed well, the position, shape and size of the reconstructed ear, the cranial angle of the reconstructed ear were symmetrical with the healthy side, the outline was clear and natural. There were 28 cases (5%) with no serious complications and 5 cases (1%) were not satisfied with the result of operation. Postoperative complications occurred in 44 cases (8%). 6 cases of hematoma, 1 case of scalp incision and fissure, 7 cases of dilatator leakage, 2 cases of dilator infection, and 2 cases of dilator infection, and 1 case of scalp incision and debridement and suture, 7 cases of dilator leakage, 2 cases of dilator infection, and 2 cases of dilator infection. 14 cases of expanded flap ruptured, 8 cases of ear stents exposed, 4 cases of wound healing after conservative treatment, 1 case of local tissue flap covering after debridement, 3 cases of temporal fascial flap covering after debridement, 4 cases of auricular stents infection, Among them, 3 cases healed after conservative treatment, and 1 case got rid of the stents after conservative treatment, which was the most serious complication; 1 case had bad healing of abdominal incision after dressing change; 3 cases had poor survival of posterior ear skin graft. The pleural injury occurred in 1 case when the costal cartilage was taken, and it was found in time during the operation and repaired after the operation, but there was no adverse reaction after operation. Conclusion: the technique of skin soft tissue expansion can increase the amount of skin behind ear, make skin thinning, provide more useful skin for auricle reconstruction, and make the appearance and contour of reconstructed ear more clear. It is especially suitable for the patients with tight or thick fascia, small skin area, low hairline and damaged skin soft tissue. The technique of "expanding single flap" auricle reconstruction is simple, less trauma and less scar. If the skin condition of the patient is allowed, it should be chosen as far as possible. Moreover, it provides an effective treatment for the patients whose skin and fascia are seriously damaged. We believe that there is no one method suitable for all patients in total auricle reconstruction. Choosing the corresponding operation method according to the individual differences of patients can give full play to the advantages of different techniques and improve the excellent and good rate of ear reconstruction.
【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】：2014
【分类号】：R764.9
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