耳后沟带蒂皮瓣修复联合循证护理对难治性耳前瘘管反复感染患儿疗效及美学效果观察

Observation on the therapeutic and aesthetic effects of posterior sulcus pedicled skin flap repair combined with evidence-based nursing on children with refractory recurrent infection of anterior ear fistula

目的探讨耳后沟带蒂皮瓣修复联合循证护理在难治性耳前瘘管反复感染患儿瘘管修复的可行性及优势。方法随机将2020年2月~2022年1月收治的83例反复感染耳前瘘管患儿分为观察组(42例)和对照组(41例),两组患儿均实施耳前瘘管切除术,对照组耳前瘘管切除后直接周围皮肤减张拉拢缝合;观察组耳前瘘管切除后游离耳后沟皮瓣带蒂翻转至耳前缝合,术后配合循证护理。观察两组术后并发症、切口愈合程度、疗效及美学效果。结果两组患儿均顺利完成手术,对照组术后并发症发生率为19.51%,明显高于观察组2.38%,差异有统计学意义(χ2=4.651,P=0.031)。观察组切口Ⅰ期愈合率高于对照组,Ⅱ期愈合率低于对照组,差异均具有统计学意义(P<0.05)。随访1年,两组患儿耳前瘘管均痊愈,治愈率均为100%,但观察组平均愈合时间为(11.63±3.24)d,明显较对照组(19.25±4.81)d短,差异具有统计学意义(t=8.483,P=0.000)。观察组美学满意度为100%,明显高于对照,85.37%,差异有统计学意义(χ2=4.623,P=0.032)。结论耳后沟带蒂皮瓣修复难治性耳前瘘管反复感染创面安全、可靠,联合循证护理可有效降低术后并发症发生率,促进切口愈合和皮瓣存活,缩短治疗时间,提高美学效果。

Objective Exploring the feasibility and advantages of posterior sulcus pedicle flap repair combined with evidencebased nursing in the repair of fistula in children with refractory recurrent infection of anterior ear fistula.Methods Randomly divide 83 children with recurrent infection of preauricular fistula admitted from February 2020 to January 2022 into an observation group(42 cases)and a control group(41 cases).Both groups of children underwent preauricular fistula resection,while the control group received direct skin tension reduction,tension,and suture after the removal of preauricular fistula;After the removal of the pre auricular fistula in the observation group,the free post auricular sulcus flap with pedicle was flipped over to the pre auricular suture,and evidencebased nursing was provided after the surgery.Observe the postoperative complications,degree of incision healing,efficacy,and aesthetic effects of both groups.Results Both groups of children successfully completed the surgery,and the incidence of postoperative complications in the control group was 19.51%,significantly higher than the observation group's 2.38%,with a statistically significant difference(χ2=4.651,P=0.031).The first stage healing rate of the observation group incision was higher than that of the control group,while the second stage healing rate was lower than that of the control group,with statistically significant differences(P<0.05).Following up for one year,both groups of children with preauricular fistula recovered with a cure rate of 100%.However,the average healing time in the observation group was(11.63±3.24)days,significantly shorter than that in the control group(19.25±4.81)days,and the difference was statistically significant(t=8.483,P=0.000).The aesthetic satisfaction of the observation group was 100%,significantly higher than that of the control group(85.37%),with a statistically significant difference(χ2=4.623,P=0.032).Conclusion The repair of recurrent infection wounds of difficult to treat anterior ear fistulas with a pedicle skin flap in the posterior ear sulcus is safe and reliable.Combined with evidence-based nursing can effectively reduce the incidence of postoperative complications,promote incision healing and flap survival,shorten treatment time,and improve aesthetic effects.