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題名 | Reconstruction for Human Bite Defect of Auricle Helix with a Posterior Auricle Advance Skin Flap=耳後推進皮瓣重建咬傷後外耳輪缺損 |
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作者 | 劉厚耕; 蕭弘道; 黃文成; Liu, Hou-keng; Hsiao, Hung-tao; Huang, Wen-cheng; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20120900 |
卷期 | 21:3 2012.09[民101.09] |
頁次 | 頁201-211 |
分類號 | 416.413 |
語文 | eng |
關鍵詞 | 耳後推進皮瓣; 咬傷; 外耳輪缺損; Human bite; Auricle helix reconstruction; Posterior auricle advance skin flap; |
中文摘要 | 背景:顏面部位的人咬傷往往造成功能與外觀的缺失。在台灣地區,對於這方面的治療與重建之相關資訊並不多。人咬傷的高感染風險傷口及外耳殼本身的細緻結構導致外耳輪缺損之治療重建困難。雖然外耳腫瘤或皮膚癌切除術後的缺損重建之相關資訊已建立完整,外耳輪之重建,使用耳後推進皮瓣並非新聞,但人咬傷造成的外耳缺損重建治療之相關討論是罕見的,尤其是在這樣可能有感染風險的傷口,常需要使用delay reconstruction及兩階段重建手術,以達到安全與完美的術後外觀。目的及目標:我們治療感染性傷口以delay reconstruction為原則,使用一階段手術:耳後推進皮瓣,重建咬傷後之外耳輪缺損,並追蹤術後傷口復原情形,來評估此手術方法之成果。材料及方法:在1993至2011年間,收集了10位因咬傷而接受耳後推進皮瓣重建外耳輪手術。有9位是人為咬傷,一位是狗咬傷。其中有4位患側位於右耳,6位在左耳。我們藉由問卷調查來了解此手術術後之成果及病患接受程度,其中因子包含:手術術後患側耳之外型、大小、色澤、疤痕組織軟硬程度及外耳後傾之角度。結果:平均傷口大小為4.3公分×2.0公分。病患對於術後外耳之形狀大小及色澤都有很高的接受滿意度。所有的皮瓣都存活,並無發生部分壞死之現象,也未發生疤痕攣縮或是感染造成的外耳變形。結論:耳後推進皮瓣可以成功地重建咬傷後之外耳輪缺損,並盡可能保持患側耳之外觀、大小。耳廓供皮區来自耳后乳突區,部位隐蔽,患者均能接受,通過10例耳後推進皮瓣重建外耳輪的臨床應用,我們認為能在短時間內恢復外型,手術成功率高,術後護理方便,不失為一種修復外耳輪的好方法。 |
英文摘要 | Background: Human bites in the maxillofacial region compromise function and aesthetics. There is paucity of information regarding human bite injuries in Taiwan. Reconstruction for human bite defect of auricle helix is difficult owing to the delicate structure of the ear and the risk of infection. Although reconstruction of auricle defects after skin cancer or tumor excision is well established, the experience and discussion about the reconstruction of human bite injury over the ear are rare, especially in such potential infected wounds.Aim and Objectives: We describe a reconstructive technique in one stage operation with delay reconstruction after the bite injury over helix and evaluate the results. Materials and Methods: Ten patients underwent helix of the auricle reconstruction using a posterior auricle advance skin flap by one surgeon during the period between 1993~2011 (19 years) were reviewed. This series included nine patients which were caused by human bite and one caused by dog bite. There are four defects over right ears and six defects over left ears. We designed a questionnaire for post-operation satisfaction survey, including similarity of size and shape, correct cephalo-auricular angle, donor site satisfaction and matching color. Results: The average size of defect is 4.3cm ×2.0cm. All of the reconstructed auricles had good three-dimensional forms with satisfactory color and texture. No post auricular skin flap fell into partial necrosis, and all of the flaps were well healed without vascular stasis. There was neither constriction of the ear nor deformation due to scar contracture.Conclusions: We report on the successful reconstruction after bite injury defects involving the helix of the auricle using a post auricular advance skin flap. There is no morbidity of the donor site and the reconstructed auricles' color and texture are excellent, the advance post-auricle flap can be an ideal donor site for coverage of the helix area of the auricle. |
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