中西医结合方法治疗左耳廓不完全断离伤1例

One case of incomplete breaking injury in the left auricle treated by integrated traditional chinese and western medicine

耳廓断离伤在临床中较为常见,主要原因为车祸、人咬伤、动物咬伤及机械切割等外伤造成患者外耳部分或全部断离。外耳缺失造成患者心理和身体重大创伤,医生应采用有效、简单修复此类耳廓断离伤,帮助患者最大限度恢复耳廓的轮廓、颜色、质地。有报导认为耳后动脉未损伤,就可直接对位缝合,否则需行显微血管吻合术、乳突区皮下包埋术及皮瓣转移修复术。本病例耳廓不完全断离伤,耳道软骨在耳道口完全被切断,仅有耳前1.5cm皮肉相连,伤口渗血。全麻清创再植术,术前、术中保护耳颞部仅存牵连组织不受损,探查发现耳廓离断端有渗血,利用“颞浅动脉分支供血的耳廓岛状皮瓣”理论指导,精心再植复位缝合受损耳廓,术后重现耳廓外观完整性。术后采用中西医结合治疗加强抗感染、清热解毒祛邪,活血祛瘀消肿等,成功治疗该例不完全耳廓离断伤病例。

Auricle breaking injury is relatively common in clinical practice.The main causes are car accidents,human bites, animal bites and mechanical cutting,which cause breaking of some or all parts of the external ears of patients.The loss of the external ear causes the patient’s psychological and physical trauma.The doctor should use an effective and simple method to repair such auricle breaking injury to help the patient to restore the outline,color and texture of the auricle to the maximum extent.It has been reported that if the posterior auricular artery is not damaged,it can be sutured directly in the contralateral position.Otherwise microvascular anastomosis,mastoid region subcutaneous embedding and flap transfer repair are needed.In this case,the auricle was not completely broken,and the cartilage of the ear canal was completely cut off at the ear canal.Only 1.5cm of the flesh was connected before the ear,and the wound was oozing.During the debridement and replantation under general anesthesia,only the involved tissues in the temporal part of the ear were protected from damage preoperatively and intraoperatively,and blood oozing was found at the breaking end of the auricle.Under the guidance of the theory of“ auricle island flap supplied by branches of the superficial temporal artery”,the damaged auricle was carefully replanted,reset and sutured.And the appearance integrity of the auricle was restored postoperatively.After the operation,the combination of traditional Chinese and western medicine was used to strengthen anti-infection,clear heat,detoxify and dispel pathogenic factors,activate blood and dispel blood stasis and swelling and so on.And the case of incomplete breaking injury in the auricle was successfully treated.