不同方法修复先天性外中耳畸形新建耳道的皮肤缺损的临床研究

Clinical study of different methods to repair the skin defect of the new ear canal of the congenital external middle ear malformation

目的:探讨异种脱细胞真皮基质修复膜与自体游离薄层皮片在先天性外中耳畸形新建耳道的皮肤缺损中的修复作用。方法:纳入2013年1月-2015年1月收治的先天性耳道狭窄或畸形患者40例,患者均行骨性外耳道重建术治疗,将其按照随机数字表法分为两组各20例:针对新建耳道皮损情况,观察组予以异种脱细胞真皮基质修复膜治疗,对照组予以自体游离薄层皮片治疗,对比分析两组治疗效果。结果:随访6个月,两组患者均未出现移植物排斥显现和脱落现象,两组患者移植成功率均达到了100%;观察组完全上皮化时间较对照组的显著缩短(P<0.05);观察组移植3个月和6个月的温哥华瘢痕评分均较对照组的显著降低(P<0.05);两组均未见严重异常反应;观察组美容满意度达到了95.00%,较对照组的85.00%显著提高(P<0.05)。结论:异种脱细胞真皮基质修复膜用于先天性外中耳畸形新建耳道皮肤缺损,可作为安全的真皮替代物,可有效促进缺损皮肤的愈合,减少创面愈合后瘢痕增生,美学效果好,有临床推广价值。

Objective To investigate the effect of repairing the skin defect of the new ear canal of the new ear canal with the acellular dermal matrix and the free thin layer of the skin.Methods 40 cases of January 2015 2013 to January 2009 in our hospital were congenital ear canal stenosis or deformity were included.All the patients underwent skeletal reconstruction of external auditory canal treatment.According to the random number table method is divided into two groups with 20 cases in each：in view of the new ear canal skin lesions,the observation group be dissimilar de cellular dermis matrix membrane repair treatment,control group was treated with autologous free thin skin graft treatment,comparative analysis the therapeutic effect of two groups.Results Patients were followed up for 6 months,patients in the two groups there were no graft rejection appeared and shedding phenomenon,the success rate of the two groups of patients transplanted reached 100%;were observed compared with control group,the group of complete epithelization time was significantly shortened（P〈0.05）;observation group transplantation 3 months and 6 months of Vancouver Scar score were lower than those in the control group decreased significantly（P〈0.05）.The two groups had no serious abnormal reaction;observation group cosmetic satisfaction reached 95%,compared to the control group 85.00% increased significantly（P〈0.05）.Conclusion Xenogenic deproteinization acellular dermal matrix membrane repair for congenital external and middle ear malformation new ear canal skin defect,as a dermal substitute,can effectively promote the skin defect of healing,reduce scar hyperplasia after the wound healing,good aesthetic effect,is worthy of clinical application.