鼻翼缩小术后血肿局部皮肤坏死1例

One case of local skin necrosis by hematoma after alar reduction

该文介绍1例鼻翼缩小术后血肿导致局部皮肤坏死的病例。患者女,20岁,在外院行膨体(综合)隆鼻加耳软骨垫鼻尖手术,同时行鼻翼缩小术。术后7 d拆线发现右侧鼻翼伤口血痂覆盖,愈合不良,给予清创缝合。清创后第7天切口缘突然出现淤黑,范围变大,给予换药治疗18 d,无好转,转至广西中医药大学第一附属医院就诊。给予清除血肿、探查出血点并电凝止血处理。术后常规换药,待坏死组织变黑变干后分次去除,经过25 d换药,无需皮瓣修复,创面愈合良好,瘢痕不明显,两侧鼻翼基本对称。提示鼻翼缩小术也应注意预防血肿,对特殊部位出现血肿,要及时处理,避免出现皮肤坏死破溃。

To introduce a case of local skin necrosis by hematoma after alar reduction.A 20-year-old female patient underwent comprehensive rhinoplasty with ear cartilage paddind nose tipand and alar reduction.After 7 days,the right nasal alar wound was covered with blood scabs,and poorly healed.Debridement and suturing were performed.On the 7th day after debridement,there was sudden blackening of the incision edge which enlarged the area.The patient was treated with dressing change for 18 days but did not improve.She came to the First Affiliated Hospital of Guangxi University of Chinese Medicine for treatment.The hematoma was cleared and the bleeding points were explored.After multiple routine dressing changes,the skin on the wound edge became necrotic,turning black and dry before removal.After 25 days of dressing changes,no skin flap repair was performed,and the wound healed without obvious scars.The nose was basically on the opposite side.Therefore,attention should also be paid to preventing hematoma during alar reduction.For small amounts of hematoma in special areas,timely treatment should be taken to avoid skin necrosis and ulceration.