儿童全耳再造术皮瓣坏死的治疗及预防

The treatment and prevention of flap necrosis aftertotal auricle reconstraction in children

目的 :探讨儿童全耳再造术皮瓣坏死的治疗原则及预防措施。方法 :回顾性分析全耳再造术患儿的临床资料。 1992～ 2 0 0 2年 ,施行全耳再造术 2 0例 (2 1只耳 ) ,16例 (17只耳 )一期愈合 ,4例 (4只耳 )发生皮瓣坏死 ,面积 1.5cm× 3cm～ 6cm×5cm。 4例分别采用患侧遗留颞浅筋膜瓣转移加全厚植皮术、同侧上臂随意皮瓣带蒂转移术修复。结果 :4例创面最终愈合 ,外形需择期修整。结论 :皮瓣坏死的治疗原则是 :适时去除坏死组织 ,首选患侧遗留颞浅筋膜瓣转移加全厚植皮术。预防全耳再造术皮瓣坏死的关键是充分保障颞浅筋膜瓣的血供。

Objective:To investigate the principle of treatment and the preventive measures of flap necrosis after total auricle reconstraction in children.Methods:From 1992 to 2002,the flap necrosis occured in 4 of 20 cases(17 ears) undergoing operation of total auricle reconstraction,the areas of necrosis was ranged from 3×1.5cm to 6×5cm. 4 cases were repaired by using remnant temporal superficial fascia flaps combining with full-thickness skin graft and random upper arm flap,respectively.Results:The wounds of 4 cases were completely healed.Conclusion:The principle of treatment is to remove necrotic tissue and to use remnant temporal superficial fascia flap with full-thickness skin graft to cover the wounds.The key of preventing flap necrosis is to maintain the blood supply of temporal superficial fascia flap.