CAJ | 학술논문

目的探讨多孔高密度聚乙烯(Medpor)及自体肋软骨支架结合扩张术,分Ⅱ期行全耳再造术后并发症的处理及防治.方法对158例应用Medpor及自体肋软骨支架结合扩张术全耳再造者进行总结和回顾分析,其中术后并发症18例(11.39％).结果扩张器血肿3例(发生率为1.90％),经治疗后痊愈；扩张器感染外露2例(发生率为1.27％),其中1例经治愈后,继续进行Ⅱ期耳再造手术,另1例治疗无效,终将扩张器取出后缝合,半年后再次行扩张器置入手术;Ⅱ期支架置入术后感染支架外露13例,其中共使用肋软骨支架121例,外露者7例(发生率为5.79％),经换药或耳后颞浅筋膜瓣转移加植皮片覆盖后创面愈合；共使用Medpor支架37例,感染外露者6例(发生率为16.22％),其中3例经治疗后痊愈,3例治疗无效,支架取出手术失败.结论术前严密设计,术中细致操作可以减少血肿发生.耳再造部位皮肤张力过大、皮瓣过薄或外力的作用是支架外露的主要原因,若及时采取适当方法处理,仍有部分可以挽回.基于Medpor支架感染外露的发生率较高及难以治愈性,应尽量选用自体肋软骨支架行全耳再造术.
목적 탐토다공고밀도취을희(Medpor)급자체륵연골지가결합확장술,분Ⅱ기행전이재조술후병발증적처리급방치.방법 대158례응용Medpor급자체륵연골지가결합확장술전이재조자진행총결화회고분석,기중술후병발증18례(11.39％).결과 확장기혈종3례(발생솔위1.90％),경치료후전유；확장기감염외로2례(발생솔위1.27％),기중1례경치유후,계속진행Ⅱ기이재조수술,령1례치료무효,종장확장기취출후봉합,반년후재차행확장기치입수술;Ⅱ기지가치입술후감염지가외로13례,기중공사용륵연골지가121례,외로자7례(발생솔위5.79％),경환약혹이후섭천근막판전이가식피편복개후창면유합；공사용Medpor지가37례,감염외로자6례(발생솔위16.22％),기중3례경치료후전유,3례치료무효,지가취출수술실패.결론 술전엄밀설계,술중세치조작가이감소혈종발생.이재조부위피부장력과대、피판과박혹외력적작용시지가외로적주요원인,약급시채취괄당방법처리,잉유부분가이만회.기우Medpor지가감염외로적발생솔교고급난이치유성,응진량선용자체륵연골지가행전이재조술.
Objective To investigate the treatment and prevention of auricle reconstruction complications by Medpor framework and autoallergic rib cartilage framework implantation.Methods A total of 158 microtia were performed ear reconstructive operation,in which postoperative complications happened in 18 cases during January 2003 to June 2011,and studied retrospectively.Results There were three cases of dilator haematoma (incidence rate was 1.90 ％),and they were cured after treatment.There were two dilator infection cases (incidence rate was 1.27 ％).One case was cured after treatment,and another one revealed no effect after treatment and dilator implantation operation was done half a year later.There were thirteen cases of framework plantation exposure and infection after Ⅱ stage operation,in which there were seven rib cartilage framework cases (incidence rate was 5.79 ％),and they were cured after change dressings and operation; there were six Medpor framework cases (incidence rate was 16.22 ％),and the three cases were cured after change dressings and operation,and other three cases revealed no effects after change dressings and so the operation failed.Conclusions Preoperative percise plan and fine manipulation can decrease the incidence of haematoma.The main reasons of framework exposure include the skin tension,thin skin flap or the effect of external force.On account of the high incidence of framework exposure and difficult treatemnt,it is better to use rib cartilage framework for uricle reconstruction.