应用颈部扩张皮肤皮管转移治疗烧伤后耳廓缺损.docVIP

应用颈部扩张皮肤皮管转移治疗烧伤后耳廓缺损[摘要]目的：介绍应用颈部扩张皮肤皮管成形并应用皮管转移治疗烧伤后耳廓缺损的方法。方法：手术分4期进行：Ⅰ期在颈下部正常皮肤处埋置扩张器，注水扩张；Ⅱ期取出扩张器，利用扩张皮瓣形成皮管；Ⅲ期皮管转移至耳后；Ⅳ期以皮管为供皮区，行外耳再造术。结果：临床应用37例患者，所有患者双侧耳对称，形态满意，仅有2例出现支架外露，经治疗后愈合。结论：应用颈部扩张皮肤皮管转移治疗烧伤后耳廓缺损，对于耳周尤其是颈部存有一定量的正常皮肤的患者，是一种较好的治疗方法。 [关键词]扩张皮瓣；皮管；烧伤后；耳廓缺损 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）08-1137-03 Repairing auricle defect after burn using the cervical expanded flap to form skin tube ZHANG Zhi-yuan, ZHAO Yan-yong, JIANG Hai-yue, ZHUANG Hong-xing,YANG Qing-hua, NIU Zhao-he, WANG Yan-mei (The Plastic and Reconstructive Center of the Ear,Plastic Surgery Hospital, Chinese Academy of Medical Science, Beijing 100041, China) Abstract:ObjectiveTo introduce a method of forming skin tube to treat auricle defect after burn using cervical expansive flap.MethodsFour stages are required in the whole process of ear reconstruction. Firstly, place an expander under the normal skin of the cervical part and effuse. Then form skin tube using the expanded flap. Thirdly, the skin tube is transposed to the postauricle area. At last, conduct ear reconstruction utilizing the skin tube.Results37 cases had been performed clinically, and all of the reconstructive ears appeared satisfactory and symmetric. Only 2 frameworks revealed, but they were healed soon after treatment.ConclusionThe a method of forming skin tube to treat auricle defect after burn using cervical expansive flap is a good therapeutic method with regard to the patient who had some normal skin in the surrounding of the ear especially in the cervical part. Key words: expanded flap; skin tube; post burn; auricle defect 对于烧伤导致的耳廓全部或部分缺损，由于其耳后瘢痕形成导致供皮区被破坏，给外耳再造手术带来了很大的困难。我科自1995年以来，利用颈部扩张皮瓣形成皮管并转移至耳后，作为外耳再造的皮肤来源，为37例烧伤后耳廓缺损的患者进行了外耳再造，取得了良好的效果。 1临床资料 37例患者37侧耳廓缺损，男21例，女16例。年龄18～43岁，平均年龄28岁，均为烧伤后耳廓全部或部分缺损，耳后均为瘢痕组织，31例为萎缩性瘢痕，6例局部有瘢痕增生，其中4例患者耳后散在存有少量正常皮肤。瘢痕活动性较好，与乳突区、颞区无明显粘连。同侧颈部存有较大面积的正常皮肤。外耳道均正常。 2手术方法 手术分为4期进行。 2.1 Ⅰ期手术：在颈中下部正常皮肤深面埋置300ml扩张器一枚，埋置层次为颈阔肌浅层。拆线后定期注水扩张，注水约400m