八大处法耳廓再造二期手术并发症的处理

The Treatment for Stage 2 Postoperative Complications of Ear Reconstruction with Ba Da Chu Method

目的探讨八大处法耳廓再造二期手术并发症的处理方法。方法回顾近两年进行的八大处法耳廓再造二期手术所发生的并发症,归类为1,皮瓣下血肿;2,皮瓣边缘血运障碍;3,植皮部分成活不良;4,支架外露(a轻,b重);5,软骨支架感染。对应的处理方法分别为:1,血肿清除;2,外用药物促进愈合;3,局部换药,外用促伤口愈合药物治疗;4a,直接修整缝合术,4b,颞筋膜转移中厚植皮术;5,局部引流冲洗,全身抗感染治疗。结果自2011年2月1日至2013年1月31日,我科共实施八大处法耳廓再造术903例,953耳,男508例,女,395例,左耳,304例,右耳,549例,双耳,50例,年龄5.5至55.4岁,中位年龄10.2岁,随访时间最短1月,最长18月,平均6月。1,皮瓣下血肿5耳,发生率为0.53%,全部治愈;2,皮瓣边缘血运障碍26耳,发生率2.73%,全部治愈;3,植皮部分成活不良35耳,发生率3.67%,全部治愈;4,支架外露11耳,发生率为1.15%,其中轻8耳,发生率为0.83%,重3耳,发生率为0.32%,伤口愈合,再造耳形态不同程度受损;5,软骨感染3耳,发生率0.32%,1耳治愈,再造耳形态未受影响,1耳软骨支架部分吸收,再造耳部分变形,1耳软骨支架大部吸收,再造耳形态丧失。结论八大处法耳廓再造二期手术的常见并发症(发生率为6.41%)为皮瓣边缘血运障碍和植皮部分成活不良,经局部用药可以治愈,对再造耳手术效果无明显影响;严重并发症为支架外露(1.12%),需通过手术进行修补,对手术效果稍有影响;灾难性的并发症为软骨感染(0.22%),处理困难,常明显影响手术效果,需要紧急处理的并发症为皮瓣下血肿(0.53%),需尽早清除,不影响治疗进程和手术效果。

Objective To explore the treatment of stage 2 postoperative complications of ear reconstruction with Ba Da Chu Method. Method Review the ear reconstruction surgery with Ba Da Chu Method we performed during the last two years. All the postoperative complications of stage 2 surgery included the following 5 kinds：l, hematoma under skin flap; 2, the unhealthy blood circulation at the edge of skin flap; 3, partial necrosis of skin graft ; 4, the framework exposure（ a, light; b, severe）; 5, the infection of cartilage framework. The corresponding treatment methods were described as follows： 1, clearing away the hematoma; 2, using external used medicine helping wound cure; 3, cleaning the invalid tissue and using external used medicine helping raw area cure; 4a, disposing the exposed cartilage and suturing the incision directly. 4b, repairing the exposed part with axis superficial temporoparietal fascia flap, transplanting skin graft covering the raw area; 5,draining the pus and washing the cavity with anti infectine agents. Result We performed 953 ear reconstruction surgeries with Ba Da Chu Method for 903 cases, male 508, female 395, left 304, right 549, bilateral 50, aged from 5.5 to 55.4 years, median age 10.2 years, the follow-up period from 1 to 18 months, average 6 months. 1, hematoma under skin flap, 5 ears （incidence rate 0.52%） were cured completely in all cases; 2, the unhealthy blood circulation at the edge of skin flap, 26 ears （incidence rate 2.73%）, were cured completely in all cases; 3, partial badness of skin graft, 35 ears （incidence rate 3.67%）, were cured com- pletely in all cases; 4, exposure of cartilage framework, l lears （incidence rate 1.15%）, light 8 ears（0.83%）,severe 3 ears （0.32%）, were cured with little damage of the new ears; 5, the framework infection, 3 ears （incidence rate 0.32%）. 1 ear were cured completely, while the shape of 2 ears distorted seriously. Conclusion The common complications post stage2 surgery of ear reconstruction with Ba Da Chu Method were unhealthy blood circulation at the edge of skin flap and partial badness of skin graft （6.41%）, which were cured with external used medicine and didn＇t damage the shape of reconstructed ears; The se- vere complications was cartilage framework exposure（1.15%）, which needed to be treated with operation and had mild dam- age to the new ears; The disastrous complications was cartilage infection, which damaged seriously the new ears; the complica- tions needing to deal with urgently was hematoma, which（0.32%） didn＇ t influence the proceeding and outcome of Ihe whole surgery.