Brent法与扩张法全耳再造术后并发症比较及Brent法术后并发症的防治  

Postoperative complications after Brent technique vs tissue expander technique of auricular reconstruction and prevention and treatment of those from the former technique

作　　者：王量[1] 戴霞[1] 李世荣[1] 吕巍[1] 王凡[1] 刘林奇[1] 沈洁[1] 廖建贵[1] 毋巨龙[1] 

机构地区：[1]第三军医大学西南医院整形美容外科,重庆400038

出　　处：《第三军医大学学报》2016年第16期1862-1867,共6页Journal of Third Military Medical University

摘　　要：目的对Brent法全耳再造与扩张法全耳再造术后并发症进行比较分析。总结Brent法全耳再造术常见并发症,分析血肿、感染、支架外露的预防和处理方法。方法回顾性分析比较Brent法与扩张法全耳再造术后出现并发症的患者的临床资料。对Brent法并发症采用畅通引流、局部抽吸处理血肿,局部引流换药处理感染,换药、局部皮瓣转移、局部筋膜瓣加游离皮片移植覆盖外露支架。结果 Brent法并发症发生率较扩张法低（P〈0.05）。其并发症经相应处理,血肿清除,伤口愈合,肋软骨支架外露覆盖。Brent法全耳再造术后支架外露多出现在一期术后4～6周,以耳后皮瓣前端与残耳组织结合部最常见,其次是耳轮后上缘交界处的外露。经过引流、换药、再次手术等处理,患者伤口均愈合,皮瓣及皮片存活。结论 Brent法并发症发生率比扩张法低。Brent法术中需注意减轻皮瓣局部张力且术后密切观察转移皮瓣血运,采用换药、皮瓣转移或筋膜瓣联合皮片移植方式修复未愈创面。Objective To analyze the differences in the postoperative complications between the Brent technique and tissue expander technique of auricular reconstruction, summarize the common complications of the former,and investigate on how to prevent and manage them,such as hematoma,infection,and framework exposure. Methods Clinical data of the patients who suffered from complications after auricular reconstruction with Brent technique or tissue expander technique in our department from October2009 to October 2015 were collected and retrospectively analyzed in this study. For those undergoing Brent technique of auricular reconstruction,drainage and puncture were used to treat hematoma,dressing change and drainage were used for infection treatment,and dressing change,local skin flap and temporal superficial fascia flaps combined with split skin graft transplantation were used in the treatment of framework exposure.Results The incidence of complications was significantly lower in Brent technique than the tissue expander technique（ P〈 0. 05）. With the above mentioned managements,the hematoma was evacuated,the wound was healed,and the framework exposure was recovered. The framework exposure commonly took place within4 ～ 6 weeks postoperatively. It occurred mostly in the junction of the mastoid skin flap and ear vestige,followed by the posterior-superior margin of the helix. After drainage,medication,surgery and other treatment again,wound healing and skin flap survival were observed in all the patients. Conclusion The incidence of complications is lower in the Brent technique than the tissue expander technique of auricular reconstruction. In the former surgery,clinicians should particularly reduce the tension of skin flap intra-operatively,and observe the blood supply of the flaps postoperatively. Dressing,skin flap transposition,or fascial flap combined with skin graft transplantation should be employed to heal the wounds.

关 键 词：Brent法 全耳再造术 手术后并发症 防治 小耳畸形 

分 类 号：R619[医药卫生—外科学] R622[医药卫生—临床医学]