对耳轮以远耳廓撕脱性离断的显微再植五例

Replantation of severed auricle distal to helix with microsurgical technique:Report of 5 cases

目的报道对耳轮以远耳廓撕脱性离断显微再植的临床经验。方法自2018年12月至2021年10月, 青岛大学附属医院手足外科共收治5例对耳轮以远的耳廓撕脱离断伤患者, 其中男4例, 女1例, 年龄19~62岁。将耳廓彻底清创后, 采用逆行再植法进行再植, 动脉:均取足背静脉桥接耳后动脉;静脉:2例直接缝合,2例取足背静脉将离断耳廓的耳后动脉分支桥接于近端耳廓的耳后静脉,1例未缝合。其中2例断耳术后发生静脉危象, 皮缘小切口放血治疗,2例动脉静脉化的断耳血运良好, 术后均行抗凝、抗血管痉挛、抗感染治疗。术后定期采用电话、微信图片等方式进行随访。结果再植5例均完全成活。术后随访3个月~2年, 平均10个月,2例静脉危象耳廓轻度萎缩, 所有耳廓均无明显色素沉着,1年后感觉恢复接近正常。结论血管质量的预判及高质量的显微缝合是耳廓再植成活的必要条件。对于撕脱性离断耳廓再植, 彻底清除损伤血管、行血管移植是预防血管危象的关键技术。

Objective To summarise the clinical experience in replantation of the severed auricle distal to helix with microsurgical technique.Methods From December 2018 to October 2021,a total of 5 patients with severed auricle injury were treated in the Department of Hand and Foot Surgery of The Affiliated Hospital of Qingdao University.They were 4 males and 1 female with 23-62 years old.After complete debridement of the auricular pinna,the retrograde replantation method was used.For arteries:a dorsal vein of the foot was used to bridge the posterior auricular artery.For veins:2 patients had the veins directly anastomosed,2 had the arteriovenous bridging to the posterior ear vein with dorsal foot veins,and the veins in 1 case were not anastomosed.Among the patients,2 developed venous occlusions after severed auricle,and were treated with bloodletting through small incision at the skin margin.Two patients who received the arteriovenous of the severed auriclse achieved good blood supply.All the patients underwent treatments including anti-freezing,anti-spasm and anti-infection after the emergency surgery.The follow-ups were conducted regularly by telephone and by display photos via WeChat after surgery.Results All 5 severed auricles were successfully replanted and survived.Postoperative follow-up ranged from 3 months to 2 years,with an average of 10 months.In the 2 cases with venous crisis,the auricles had mild atrophy.All auricles had no obvious pigmentation,and had the sensation recovery back to normal in 1 year after surgery.Conclusion The pre-judgment of blood vessel quality and high-quality microsurgery skills are the necessary pre-conditions for auricle replantation.For replantation of severed auricle,it is the key to prevent vascular crisis by having the injured blood vessels thoroughly removed.