自体肋软骨联合膨体材料在耳廓再造中的应用及术后外露的修补方法

Application of Autologous Costal Cartilage Combined with Expanded Material in Auricle Reconstruction and Postoperative Exposure Repair Method

目的:探究自体肋软骨联合膨体材料在耳廓再造中的应用及术后外露的修补方法。方法:选取2016年9月-2018年9月74例需进行耳廓再造患者作为研究对象,按照随机数字表法分为两组,各37例,对照组患者仅使用自体肋软骨,观察组患者使用自体肋软骨联合膨体材料进行耳廓再造。耳廓再造术采用改良的Nagata二期法完成。比较两组患者手术效果评价及术后外露的发生率,分析术后外露的原因及修补方法。结果:与对照组比较,观察组患者满意率较高、不满意率较低,且术后外露发生率较低,差异均具有统计学意义(P<0.05)。术后外露原因:①伤口愈合不良,导致软骨外露及感染;②筋膜瓣及耳前皮瓣未固定于软骨支架上,筋膜瓣与皮瓣交界处伤口裂开;③皮片存活欠佳。外露修补方法:感染时,立即行清创术,清除脓液,将肋软骨坏死组织切除,后期行修复术。肋软骨坏死较少,将筋膜瓣固定于软组织创缘,覆盖外露支架,再移植皮片修复。肋软骨坏死较多,应再次取肋软骨。结论:自体肋软骨联合膨体材料应用于耳廓再造中疗效较好,术后外露发生率低;采用合适的修补方法,可改善术后外露患者预后。

Objective To investigate the application of autologous costal cartilage combined with expanded materials in auricle reconstruction and postoperative exposure repair methods.Methods From September 2016 to September 2018,74 patients with auricular reconstruction were selected as subjects.According to the random number table method,37 patients were divided into two groups.The control group only used autologous costal cartilage.The observation group used autologous costal cartilage combined with expanded material for auricle reconstruction.Auricle reconstruction was performed using the modified Nagata Phase II method.The evaluation of surgical results and the incidence of postoperative exposure were compared between the two groups,and the causes and repair methods of postoperative exposure were analyzed.Results Compared with the control group,the patients in the observation group had higher satisfaction rate and lower dissatisfaction rate,and the differences were statistically significant(P<0.05).Compared with the control group,the incidence of postoperative exposure was lower in the observation group(P<0.05).Causes of postoperative exposure:poor wound healing,resulting in cartilage exposure and infection,fascia flap and anterior skin flap were not fixed on the cartilage scaffold,the wound was ruptured at the junction of the fascial flap and the flap,the skin survived poorly.Exposed repair method:Immediately during infection,debridement is performed to remove pus,the costal cartilage necrosis tissue is removed,and the repair is performed later.The costal cartilage is less necrotic.The fascia flap is fixed on the soft tissue wound edge,covering the exposed stent,and then the graft is repaired.The costal cartilage is more necrotic,and the costal cartilage should be taken again.Conclusion The autologous costal cartilage combined with expanded material has a good effect on auricle reconstruction,and the incidence of postoperative exposure is low.Appropriate repair methods can improve the prognosis of patients exposed to surgery.