本文選題：小耳畸形 + 外耳再造�。� 參考：《北京協(xié)和醫(yī)學院》2017年碩士論文

【摘要】：目的:外耳再造是整形外科中最具有挑戰(zhàn)的手術(shù)之一。及時、正確地處理其并發(fā)癥,對手術(shù)效果具有重要意義。肋軟骨支架移植后皮膚破潰是外耳再造術(shù)后常見的并發(fā)癥之一,處理不當可能會導(dǎo)致軟骨支架外露甚至感染而取出肋軟骨支架。本研究旨在總結(jié)外耳再造手術(shù)后14個月內(nèi)發(fā)生術(shù)后皮膚破潰的病例,以期為臨床提供參考。方法:選取中國醫(yī)學科學院整形外科醫(yī)院整形七科從2016年1月1日-2017年2月28日就診于我科行皮膚擴張法外耳再造2期手術(shù)的患者共367人,374耳。其中男260人,女107人,左耳123,右耳237,雙耳7。年齡5-37歲,平均年齡10.6歲。從中選擇出現(xiàn)皮膚破潰導(dǎo)致軟骨支架外露而需入院手術(shù)干預(yù)治療的患者。結(jié)果:發(fā)生術(shù)后再造耳軟骨支架外露的而需入院手術(shù)治療的患者需入院手術(shù)治療3例,發(fā)生率為0.82%,其中一例接受局部筋膜瓣轉(zhuǎn)移+游離植皮,一例接受顳淺筋膜瓣(以顳淺動脈為蒂)合并皮片移植法修復(fù),一例清創(chuàng)后縫合。修復(fù)后,平均術(shù)后隨訪三個月,傷口甲級愈合,未出現(xiàn)皮膚破潰及軟骨支架外露,軟骨支架亦未變形、吸收。結(jié)論:再造耳皮膚破潰后,經(jīng)清創(chuàng)后行顳淺筋膜瓣(以顳淺動脈為蒂)+皮片移植,局部筋膜瓣+游離植皮修復(fù),或直接清創(chuàng)縫合;根據(jù)軟骨支架外露程度選擇修復(fù)方法,預(yù)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.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R764.9;R622

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