颞浅筋膜瓣联合离断耳廓组织回植急诊修复部分耳廓完全离断伤的长期随访  

The long-term follow-up of emergency repair of partial auricle of complete separation by superficial temporal fascia flap combined with severed auricle reimplantation

作　　者：陈琛 王振宇 王洪一 金元 梁久龙 Chen Chen;Wang Zhenyu;Wang Hongyi;Jin Yuan;Liang Julong(Postgradute Training Base,General Hospital of Northern Theater Command,Jingzhou Medicine University,Shenyang 110000,China;Department of Burn and Plastic Surgery,General Hospital of Northern Theater Command,Shenyang 110000,China)

机构地区：[1]锦州医科大学解放军北部战区总医院研究生培养基地,沈阳110000 [2]解放军北部战区总医院烧伤整形科,沈阳110000

出　　处：《中华整形外科杂志》2024年第8期878-884,共7页Chinese Journal of Plastic Surgery

基　　金：辽宁省科技厅科学技术计划项目(2023JH2/101300061)。

摘　　要：目的观察颞浅筋膜瓣联合离断耳廓组织回植急诊修复部分耳廓完全离断伤的远期效果。方法回顾性分析2014年6月至2023年8月解放军北部战区总医院烧伤整形科急诊收治的部分耳廓完全性离断患者资料,均采用颞浅筋膜瓣联合离断耳廓组织回植进行修复。术中先切取颞浅筋膜瓣并保留蒂部,之后剥离离断耳廓软骨作为再植支架,修剪剥离软骨后的皮肤,制成全厚皮片;参照对侧耳廓位置及角度,将软骨支架缝合固定于耳软骨残端,依次采用颞浅筋膜瓣和全厚皮片覆盖后打包、缝合。术后观察皮瓣、皮片愈合情况,以及是否出现感染、血肿等并发症。术后进行1年以上长期随访,评估再造耳廓的形态、色泽、质地及触觉恢复情况;采用温哥华瘢痕量表(VSS)评估供、受区瘢痕情况,总分0~15分,分数越高表示瘢痕程度越严重;采用Likert 5级评分法评估患者对手术效果的满意度,总分30分,≥27分为非常满意,24~26分为有些满意,18~23分为无所谓,15~17分为有些不满意,≤14分为非常不满意。结果共纳入8例患者,男5例,女3例;年龄26~65岁,平均41岁;均为单侧耳部缺损,左耳3例,右耳5例;缺损面积为1.5 cm×2.5 cm~5.0 cm×4.0 cm。术中颞浅筋膜瓣切取面积为4.5 cm×6.5 cm~15.0 cm×10.0 cm。术后皮瓣、皮片均顺利成活,供区与受区均一期愈合,未见皮瓣、皮片坏死、感染、血肿等并发症。随访3~9年,平均约6.3年,除1例需行二次皮片削薄手术外,其余患者修复后的耳廓与健侧基本一致,轮廓线条流畅,皮肤颜色、质地与周围组织接近,触觉敏感度提高。末次随访时患者供、受区瘢痕不明显,VSS评分均≤3分,患者对手术效果均评价为非常满意。结论对于没有再植条件的部分耳廓完全离断伤,采用颞浅筋膜瓣复合离断耳廓组织修复是一种可靠且有效的治疗方式,术后远期效果良好,患者满意度高。ObjectiveTo observe the long-term effect of superficial temporal fascia flap combined with severed auricle reimplantation in emergency repair of partial auricle of complete separation.MethodsThe data of patients with partial auricle of complete separation admitted to Emergency Clinic of Burn and Plastic Surgery of General Hospital of Northern Theater Command from June 2014 to August 2023 were retrospectively analyzed.All of them were repaired with a superficial temporal fascia flap combined with amputating auricle reimplantation.During the operation,the superficial temporal fascia flap was harvested,and the pedicle was preserved.Then the detached auricular cartilage was removed and used as a replantation scaffold.Then the remaining skin was thinned to create a full-thickness skin graft after cartilage detachment.Referring to the position and angle of the contralateral auricle,the cartilage scaffold was sutured and fixed at the stump of the ear cartilage.The wound was covered with a superficial temporal fascia flap and a full-thickness skin graft,and then packed and sutured.The postoperative observation indicators mainly confirm whether the surgery was successful,the healing condition of the replanted ear,and whether there were problems such as skin flap necrosis,infection,hematoma,etc.The shape,color,texture and tactile recovery of the reconstructed auricle were evaluated by long-term follow-up for more than 1 year.The Vancouver scar scale(VSS)was used to assess scarring in both donor and recipient sites(total score of 0-15 points,higher scores indicated more severe scarring).The Likert 5-level scoring method was used to evaluate the patients’satisfaction with the surgical results(total score of 30 points,≥27 points were very satisfied,24-26 points were somewhat satisfied,18-23 points were indifferent,15-17 points were somewhat dissatisfied,≤14 points were very dissatisfied).ResultsA total of 8 patients were enrolled,including 5 males and 3 females.Their ages ranged from 26 to 65 years,with an average of 41

关 键 词：耳廓 颞浅筋膜瓣 急诊处理 随访研究 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]