Tjellström A
Department of Otolaryngology, Sahlgren's Hospital, University of Göteborg, Sweden.
Clin Plast Surg. 1990 Apr;17(2):355-66.
Tissue-integrated skin-penetrating implants placed in the mastoid process have been used in 94 patients for the retention of silicone rubber auricular prostheses. The surgery is performed in two stages with a 3- to 4-month interval between the first and second stage in order to establish osseointegration. During the first stage, implants made out of commercially pure titanium are placed in the bone. A gentle surgical technique is imperative in order not to damage the osteocytes, which might otherwise result in a fibrous encapsulation instead of a direct contact between implant and bone (osseointegration). The implants are handled with titanium-coated instruments only, and never by the gloved hand directly. Even minute sterile contaminants on the surface of the implant may jeopardize osseointegration. The skin penetration is performed during the second stage. This procedure includes a subcutaneous tissue reduction aimed at reducing mobility between the implant and the skin. To facilitate cleaning, the skin should be devoid of hair follicles. If necessary, a hairless skin graft from the upper arm is used. Three to four weeks after the second stage, the healing has normally reached the point at which the prosthesis can be made and attached to the implants. The frequency of adverse skin reactions around the penetration has been registered carefully. All in all, 2458 observations were made over a 10-year period. Only 3.5 per cent of these called for active treatment.
置于乳突的组织整合式皮肤穿透植入物已用于94例患者，以固定硅橡胶耳廓假体。手术分两阶段进行，第一阶段和第二阶段之间间隔3至4个月，以便实现骨整合。在第一阶段，将商业纯钛制成的植入物植入骨内。必须采用轻柔的手术技术，以免损伤骨细胞，否则可能导致纤维包裹，而非植入物与骨之间的直接接触（骨整合）。植入物仅用涂有钛的器械处理，绝不能直接用戴手套的手触碰。植入物表面即使有极微小的无菌污染物也可能危及骨整合。皮肤穿透在第二阶段进行。该操作包括皮下组织缩减，目的是减少植入物与皮肤之间的活动度。为便于清洁，皮肤应无毛囊。如有必要，可使用上臂的无毛皮片。第二阶段后三至四周，愈合通常已达到可制作假体并将其连接到植入物的程度。已仔细记录穿透部位周围不良皮肤反应的发生频率。在10年期间共进行了2458次观察。其中只有3.5%需要进行积极治疗。
