两种带蒂皮瓣修复耳郭、外耳道缺损的临床效果及手术方法分析

Analysis of the clinical results and surgical methods for two kinds of pedicled flaps in the repair of auricle and external auditory canal defects

目的探讨采用耳后动脉耳支为蒂皮瓣修复耳郭皮肤缺损及以耳后动脉枕支为蒂皮瓣修复外耳道皮肤缺损的临床效果及手术方法。方法选取自2011-2016年收治的29例耳郭、外耳道皮肤缺损患者进行研究,采用耳后动脉耳支为蒂皮瓣修复耳郭皮肤缺损及以耳后动脉枕支为蒂皮瓣修复外耳道皮肤缺损,总结手术方法及手术效果。结果本组29例患者,均成功完成手术,平均手术时间(62.1±15.3)min;皮瓣均完全存活,手术切口均甲级愈合,未出现坏死、感染等并发症。术后1个月,患侧耳长度、宽度测量值与健侧比较,差异均无统计学意义(P>0.05);术后第1天,患侧耳甲腔、耳轮廓的温度均低于健侧,差异具有统计学意义(P<0.05);术后第3、7天,患侧耳甲腔、耳轮廓的温度与健侧比较,差异均无统计学意义(P>0.05);术后第3个月,患者主观评价满意17例,较满意8例,一般4例,主观满意率86.21%;医师客观评价满意16例,较满意10例,一般3例,主观满意率89.67%。结论采用耳后动脉耳支为蒂皮瓣修复耳郭皮肤缺损及耳后动脉枕支为蒂皮瓣修复外耳道皮肤缺损技术可行,术后外观满意度较高。

Objective To explore the clinical effect and surgical method in the repair of auricle and external auditory canal skin defect. Methods From 2011 to 2016, 29 cases of auricle and external auditory canal skin defect were involved in the study. Auricle skin defects were repaired with ramus auricularis arteriae auricularis posterioris pedicled flaps and external auditory canal skin defects were repaired with ramus occipitalis arteriae auricularis posterioris pedicled flaps. A summary of the operation methods and clinical results was made. Results All operations were completed successfully, and the average operative time was（62.1±15.3） min. All flaps survived completely, and the operation incisions healed to class A standards. No necrosis, infection or other complications occurred. There was no significant difference of length or width of the injured ear compared with the uninjured side（P〈0.05） at one month postoperative. The temperature of the cavum conchae and the contour of the injured ear was lower than that of the healthy side on the first day postoperative, and the difference was statistically significant（P〈0.05）. At 3 and 7 days postoperative, the temperature of the cavum conchae and the contour between the injured and the healthy ear showed no significant difference（P〈0.05）. At 3 months after the operation, the subjective evaluation was satisfactory in 17 cases, moderately satisfactory in 8 cases, and generally satisfactory in 4 cases. The subjective satisfaction rate was86.21%. The objective evaluation of the surgeon was satisfactory in 16 cases, moderately satisfactory in 10 cases, and generally satisfactory in 3 cases. The objective satisfaction rate was 89.67%. Conclusion Auricle skin defects repaired with ramus auricularis arteriae auricularis posterioris pedicled flaps and external auditory canal skin defects repaired with ramus occipitalis arteriae auricularis posterioris pedicled flaps can obtain a relatively high satisfaction rate among both surgeons and patients.