【摘要】：目的：研究皮膚軟組織擴(kuò)張技術(shù)在耳廓再造中的臨床應(yīng)用,并對手術(shù)效果進(jìn)行評價(jià)和討論,以期為耳廓缺損患者提供更優(yōu)化的治療方法。 方法：自2011年8月至2014年1月,共計(jì)544例耳廓缺損患者接受擴(kuò)張法耳廓再造術(shù)。根據(jù)患者乳突區(qū)皮膚軟組織條件以及患者及其家屬的意愿,459例患者接受“擴(kuò)張兩瓣法”耳廓再造術(shù),85例患者接受“擴(kuò)張單瓣法”耳廓再造術(shù)。兩種方法的手術(shù)步驟均分三期完成：一期耳后擴(kuò)張器置入術(shù)。二期肋軟骨采取,耳支架雕刻,擴(kuò)張器取出,耳支架包裹。三期再造耳修整,耳屏再造,耳垂轉(zhuǎn)位,耳甲腔加深。兩種方法的不同之處在于,二期手術(shù)時(shí)“擴(kuò)張兩瓣法”耳廓再造術(shù)需利用耳后擴(kuò)張皮瓣聯(lián)合耳后筋膜瓣加皮片移植包裹耳支架,而“擴(kuò)張單瓣法”耳廓再造術(shù)僅單純利用擴(kuò)張皮瓣包裹耳支架。 結(jié)果：本組患者術(shù)后隨訪1-29個(gè)月,平均隨訪10個(gè)月。511例(94%)患者認(rèn)為術(shù)后效果滿意,再造耳愈合良好,再造耳位置、形態(tài)、大小、耳顱角與健側(cè)基本對稱,輪廓清晰、自然、穩(wěn)定,無嚴(yán)重并發(fā)癥發(fā)生;28例(5%)患者認(rèn)為手術(shù)效果可以接受;5例(1%)患者對手術(shù)效果不滿意。本組病例出現(xiàn)術(shù)后并發(fā)癥44例(8%)。其中血腫6例,清除血腫后順利擴(kuò)張；頭皮切開裂開1例,清創(chuàng)縫合后順利擴(kuò)張；擴(kuò)張器滲漏7例,擴(kuò)張器置換后順利擴(kuò)張；擴(kuò)張器感染2例,最終取出擴(kuò)張器；擴(kuò)張皮瓣破裂14例,都提前進(jìn)行手術(shù)；耳支架外露8例,其中4例換藥保守治療后創(chuàng)面愈合,1例清創(chuàng)后局部組織瓣覆蓋,3例清創(chuàng)后顳頂筋膜瓣覆蓋；耳支架感染4例,其中3例保守治療后愈合,另有1例患者保守治療無效,取出耳支架,為最嚴(yán)重并發(fā)癥；腹部切口愈合不良1例,經(jīng)換藥治療后愈合；耳后植皮成活不良3例,經(jīng)換藥治療均治愈；肋軟骨采取時(shí)胸膜損傷1例,術(shù)中及時(shí)發(fā)現(xiàn)后修復(fù)胸膜,術(shù)后無不良反應(yīng)。 結(jié)論：應(yīng)用皮膚軟組織擴(kuò)張技術(shù),增加了耳后皮膚量、使皮膚變薄,為耳廓再造術(shù)提供了更多可用的皮膚,并使得再造耳外觀及輪廓更加清晰。尤其適合于耳后皮膚筋膜緊或厚,皮膚面積小,發(fā)際線低,耳后皮膚軟組織受到破壞的患者。“擴(kuò)張單瓣法”耳廓再造術(shù)技術(shù)簡單,創(chuàng)傷小,瘢痕少,如患者皮膚條件允許應(yīng)盡量選擇；而且,為耳后皮膚、筋膜都受到嚴(yán)重破壞的患者,提供了一種有效的治療手段。我們認(rèn)為,在全耳廓再造中,沒有一種方法適合于所有患者,根據(jù)患者個(gè)體差異選擇相應(yīng)的術(shù)式,可以更充分地發(fā)揮不同技術(shù)的優(yōu)勢,提高再造耳的優(yōu)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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R764.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李鋼;劉林]，

本文編號：2171765