全耳再造术并发症的处理及防治  

Prevention and treatment of the complications of auricle reconstruction

作　　者：陈亮[1] 李晓格[1] 李世荣[1] 李喆[1] 戴霞[1] 毋巨龙[1] 

机构地区：[1]重庆市第三军医大学西南医院整形外科,400038

出　　处：《中华医学美学美容杂志》2012年第2期108-111,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨多孔高密度聚乙烯（Medpor）及自体肋软付支架结合扩张术。分Ⅱ期行令耳再造术后并发症的处理及防治。方法对158例应用Medpor及自体肋软骨支架结合扩张术全耳再造者进行总结和回顾分析，其中术后肝发症18例（11．39％）。结果扩张器血肿3例（发生率为1．90％）．经治疗后痊愈；扩张器感染外露2例（发生率为1．27％）．其中1例经治愈后．继续进行Ⅱ别耳再造手术，另1例治疗无效，终将扩张器取出后缝合，半年后再次行扩张器髓入手术；Ⅱ期支架置入术后感染支架外露13例，其中共使用肋软骨支架121例．外露行7例（发生率为5．79％），经换药或耳后颁浅筋膜瓣转移加植皮片覆盖后创面愈合；兆使用Medpor支架37例，感染外露者6例（发生率为16．22％），其中3例经治疗后痊愈，3例治疗无效，支架取出手术失败。结论术前严密设计，水中细致操作可以减少血肿发生。耳冉造部位皮肤张力过大、皮瓣过薄或外力的作用是支架外露的主要原因．若及时采取适当方法处理．仍有部分可以挽回。基于Medpor支架感染外露的发生率较高及难以治愈性，应尽量选用自体肋软骨支架行全耳冉造术。Objective To investigate the treatment and prevention of auricle reconstruction complications by Medpor framework and autoallergic rib cartilage framework implantation. Methods A total of 158 microtia were performed ear reconstructive operation, in which postoperative complicalions happened in 18 cases during January 2003 to June 2011, and studied retrospectively. Results There were three cases of dilator haematoma （incidence rate was 1.90%）, and they were cured after treatment. There were two dilator infection cases （incidence rate was 1.27 %）. One case was cured after trealment, find another one revealed no effect after treatment and dilator implantation operation was done half a year later. There were thirteen cases of framework plantation exposure find infection after II stage operation, in which there were seven rib cartilage framework cases （incidence rate was 5.79 %）, and they were cured after change dressings and operation; there were six Medpor frame work cases （incidence rate was 16.22 %）, and the three cases were cured after change dressings and operation, and other three cases revealed no effects after change dressings and so the operation failed. Conclusions Preoperative percise plan and fine manipulation can decrease the incidence of haematoma. The main reasons of framework exposure include the skin tension, thin skin flap or the effect of exter hal force. On account of the high incidence of framework exposure and difficult treatemnt, it is better to use rih cartilage framework for uricle reconstruction.

关 键 词：全耳再造术 自体肋软骨 多孔高密度聚乙烯 支架 扩张器 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]