【摘要】：目的:探討應用耳后彎曲矩形滑行推進皮瓣修復中重度耳輪皮膚缺損的方法和應用。方法:自2015年3月至2016年7月,采集山西醫(yī)科大學第一附屬醫(yī)院整形燒傷外科診治的20例中重度耳輪皮膚缺損患者(耳輪皮膚缺損的原因包含各種外傷,人或動物咬傷,腫瘤等),其采用耳后彎曲矩形滑行推進皮瓣的方法進行修復,一期行耳輪缺損區(qū)清創(chuàng)準備/腫物切除—殘端耳后埋植術,6周后二期行耳輪斷蒂成形術,耳后供瓣區(qū)應用乳突區(qū)彎曲矩形滑行推進皮瓣進行修復。所有手術均由同一位主刀醫(yī)生完成,術后隨訪觀察時間為6-15個月。采用直接觀察法,POSAS量表,評價應用耳后彎曲矩形滑行推進皮瓣修復中重度耳輪皮膚缺損的術后效果。計量資料用均數±標準差()表示,計數資料用百分數表示,患者與觀察者之間對術后效果的滿意度用卡方檢驗。全部資料用SPSS17.0for windows統(tǒng)計。檢驗水準α=0.05。3.研究結果(1)直接觀察法:本課題20例患者無一出現感染、傷口哆開,斷蒂及滑行推進皮瓣均成活良好,其中18例患者患側耳外形良好,輪廓流暢,厚度、色澤等與周圍皮膚相似,耳后乳突區(qū)瘢痕增生不明顯,接口處無明顯凹凸感;其中1例患者術后患側耳略顯臃腫,線條不夠流暢,且色澤較周圍皮膚較深;1例患者耳后耳輪及乳突區(qū)瘢痕增生比較明顯。sx±(2)POSAS量表結果:患者術后滿意度達85%,觀察者滿意度達90%,且患者與觀察者滿意度評估差別無統(tǒng)計學意義。結論:應用耳后彎曲矩形滑行推進皮瓣修復中重度耳輪皮膚缺損,具有操作簡單,術后外觀良好,視覺差異性小,供瓣區(qū)瘢痕隱蔽,值得臨床推廣應用。
[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 鹵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 鹵(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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R622

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