皮肤软组织扩张器应用于耳缺失修复中破裂原因分析及预防

The Cause Analysis and Prevention of Cracking of Skin Tissue Expander Applied for Ear Deformity Surgery

目的 探讨耳缺失整形修复中皮肤软组织扩张器破裂的原因及预防措施。方法 回顾性分析 2013年 1 月－ 2015 年 3 月耳缺失修复患者行全耳再造皮肤软组织扩张器置入术后注水期间发生破裂的原因及预防措施,予加强健康宣教、辅以保护耳外套的应用、正确注水、总结经验并采取积极有效的预防措施等,以预防和减少皮肤软组织扩张器破裂的发生。结果 149 例患者共 153 只耳,使用皮肤软组织扩张器 151 只,皮肤软组织扩张器置入术后注水期间发生破裂 7 只,发生率为 4.64%,其中有 5 只发生在注水后期,皮瓣大小接近预期,经取出扩张器立即行Ⅱ期手术取得满意效果,另外 2 只发生在扩张器注水前期,因扩张皮瓣未达到预期条件,予以取出破裂扩张器,重新置入注水扩张,Ⅱ期手术也获得满意效果。7 例患者Ⅲ期手术造型效果均较好。三期术后,所有患者随访 3 ～ 6个月,均对手术效果非常满意,且无任何并发症发生。结论 严格注水指征和方法并采取有效的健康宣教及预防措施可减少或避免皮肤软组织扩张器应用于耳缺失修复中破裂的发生率。

Objective To explore the causes and prevention measures of the cracking of skin tissue expander applied for ear deformity surgery. Methods We retrospectively analyzed the clinical data of the patients who underwent ear reconstruction surgery with skin tissue expander which cracked during water injection after surgery between January 2013 and March 2015. And then we analyzed the causes and summarized the preventive measures, such as strengthening health education, protective ear cap application, and correct water injection. Results We collected a total of 149 patients including 153 deformity ears, and 151 skin tissue expanders were used. Skin tissue expander cracking occurred in 7 ears during water injection after surgery with an incidence of 4.64%. Among the seven cases, 5 cases of cracking occurred in the late water injection period when the skin flap size was almost close to expectations; these 5 patients underwent stage- two surgery after the expanders were taken out, and the results were satisfactory. The other 2 ears had expander cracking in the early water injection period, so we took out the skin tissue expander and implanted it again, and the second phase surgery was also satisfactory. The third-stage surgery for the seven cases was all successful. After the third-stage surgery, all patients were followed up for 3 to 6 months, and the outcomes were satisfying without any complications. Conclusion To reduce or avoid skin tissue expander cracking, we should master strict terms of water injection and take effective health education and preventive measures.