耳廓再造术中扩张皮瓣破溃感染预防及处理.docVIP

耳廓再造术中扩张皮瓣破溃感染预防及处理[摘要]目的:观察在利用扩张皮瓣结合肋软骨雕刻耳支架移植进行耳廓再造过程中发生扩张皮瓣破溃感染时耳廓再造的治疗。方法:58例先天性小耳畸形患者,于耳后皮瓣扩张过程中发生了扩张皮瓣破溃、感染等并发症,根据不同情况,28例行即刻耳廓再造术,15例行扩张皮瓣舒平,延期耳廓再造术,12例行扩张器取出的延期重新扩张的耳廓再造术,3例经抗感染治疗,继续扩张过程。结果:58例患者术后再造耳效果良好。结论:在利用皮肤扩张法进行耳再造术时,即使发生了扩张皮瓣破溃、感染等并发症,经适当的积极治疗,可望获得良好的效果。 [关键词]皮肤扩张;并发症;耳廓再造 [中图分类号]R764.9[文献标识码]A[文章编号]1008-6455(2010)03-0410-04 Infection and necrosis of expanded postauricular flaps during auricle reconstruction: effective management and risk factors ZHANG Jin-guang,HE Le-ren,ZHUANG Hong-xing,JIANG Hai-yue,YANG Qing-hua (Auricular Reconstructive Center,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100144,China) Abstract:ObjectiveToanalysis the risk factors of the Infection and necrosis of expanded postauricular flaps during auricle reconstruction and to provide effective management strategies for complication in expanding postauricular flaps.MethodsData were gathered retrospectively for cases of partial necrosis and infection of expanding postauricular flaps from the 58 casesof patients undergoing auricular reconstruction after preliminary tissue expansion. Treatmentincluded the following:①auricular reconstruction with autologous costal cartilage framework immediately(28 cases); ②stretchingthe expanded postauricular flap and fixed in place after expander removal(15cases);③removal of the expander and reinsertion of a similar expander more than 6 months after the wound had healed(12cases);④continuing expansion after antibiotic treatment(3cases).ResultsEach method was applied to different types of cases. Most cases obtained a satisfactory contour and profile of the reconstructed auricle.ConclusionsSome individual and risks factors are involved in infection and necrosis of expanded postauricular flaps, which can be prevented and minimized.An optimal method can be chosen to treat every case of infection and partial necrosis of the expanded postauricular flap. Key words: skin expansion;inf