Skin necrosis.
Skin necrosis.
复制标题
DOI：
10.1159/000350972
复制
发表时间：
2014
影响因子：
--
通讯作者：
Ryosuke Tamura;K. Mizuguchi;H. Asato
中科院分区：
文献类型：
--
作者：
Ryosuke Tamura;K. Mizuguchi;H. Asato
由于软骨移植后为移植框架而创建的皮下袋中的循环不足，可能会发生部分真皮坏死。为了防止坏死，重要的是在创建皮下袋时不要损伤皮下血管丛，并以恒定的厚度抬高皮瓣。直的手术剪可用于此目的。当创建框架时，如果软骨成角或耳轮或对耳轮太高，则皮下囊袋的皮肤上会承受太大的压力。因此，同样重要的是不要使框架的周边成角度，并且在手术期间用球囊扩张皮肤以提供充足的空间。敷料不应施加太大压力。为防止不锈钢钢丝外露，应将钢丝结节（尤其是凸形部分）置于背部并埋入，以免从软骨表面突出。耳廓抬高过程中，耳廓后部皮肤移植物的一部分也可能发生真皮坏死。特别是在支撑软骨部位可能会发生，因此支撑软骨应覆盖有良好循环的TPF，并应特别注意连接敷料。当观察到皮肤坏死时，首先用前列腺素软膏治疗。如果随后出现皮肤缺损并暴露软骨，如果受影响的区域较小，则成纤维细胞生长因子（bFGF）是一种非常有效的保守疗法[1]。当皮肤缺损面积过大，无法直接闭合时，可从耳廓后或耳廓前取局部皮瓣覆盖，或TPF覆盖后植皮[2]。下面显示的是一个皮肤缺损的保守治疗和另一个需要手术治疗的病例。
Partial dermal necrosis may develop due to insufficient circulation in the subcutaneous pocket created for transplantation of the framework after cartilage transplantation. To prevent necrosis, it is important not to damage the subcutaneous vascular plexus when creating a subcutaneous pocket and to elevate the skin flap at a constant thickness. Straight operating scissors are useful for this purpose. When creating the framework, too much pressure is placed on the skin of the subcutaneous pocket if cartilages are angular or the helix or antihelix is too high. Therefore, it is also important not to make the periphery of the framework angular and to expand the skin with a balloon during surgery to provide ample space. The dressing should not apply too much pressure. To prevent exposure of a stainless wire, nodules of wire, particularly at the convex part, should be placed at the back and embedded so as not to project from the surface of the cartilage.Dermal necrosis may also develop during elevation of the auricle at a part of the skin graft on the posterior auricle. It is likely to develop particularly at the site of the buttress cartilage, so buttress cartilage should be covered with TPF with favorable circulation, and special care should be taken with the tie-over dressing. When dermal necrosis is observed, initially treat it with prostaglandin ointment. If a skin defect subsequently develops and the cartilage is exposed, fibroblast growth factor (bFGF) is a very effective conservative therapy if the affected area is small [1]. When the area of skin defect is too large to close directly, cover it with a local flap from the posterior or anterior auricle, or perform skin grafting after covering with TPF [2]. Shown below is one case of a skin defect managed with conservative therapy and another that required surgery.