全扩张皮瓣法矫正小耳畸形一期手术的并发症分析及临床体会  

Clinical experience and analysis on the complications of the one-stage surgery with prolonged tissue expansion in microtia reconstruction

作　　者：刘翔宇[1] 刘宗辉 王璐[1] 郭树忠[1] Liu Xiangyu;Liu Zonghui;Wang Lu;Gao Shuzhong(Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi＇art Jiaotong University, Xi＇an 710061, China)

机构地区：[1]西安交通大学第一附属医院整形美容颌面外科,710061

出　　处：《中华整形外科杂志》2018年第3期192-196,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨全扩张皮瓣法矫正小耳畸形一期手术的操作要点、常见并发症的处理及临床体会。方法回顾分析了2016年6月至2017年6月，西安交通大学第一附属医院整形美容颌面外科收治的211例小耳畸形患者，行全扩张皮瓣法再造耳廓一期手术的相关资料，对术后并发症进行分析，对现有技术进行改进。结果本组211例患者，共出现并发症10例，其中血肿4例，扩张器外露3剜，感染2例，皮瓣远端血运障碍伴头部剧烈疼痛1例。血肿经冲洗引流后得以清除；扩张器外露病例经彻底清创、重新缝合后扩张器得以还纳；感染经局部灌注及全身使用有效抗生素后得以控制；皮瓣远端血运障碍伴头部剧烈疼痛经减少注射容量后得以缓解。3个月后，211例患者均顺利实施二期耳廓再造手术，术后效果满意。结论一期手术是全扩张皮瓣法矫正小耳畸形的关键，严格把握手术要点，正确认识并及时处理术后并发症，或可使其不影响后续手术的顺利开展。Objective To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications. Methods 211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi＇an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology. Results 211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard dehridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction. Conclusions Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.

关 键 词：软组织扩张器 小耳畸形 手术后并发症 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]