Levin B C, Adams L A, Becker G D
Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Medical Center, Panorama City, Calif, USA.
Arch Otolaryngol Head Neck Surg. 1996 Jan;122(1):59-66; discussion 67. doi: 10.1001/archotol.1996.01890130051008.
To evaluate secondary intention healing of full-thickness skin defects of the auricle. Immediate reconstruction of full-thickness skin defects after cancer surgery is an accepted surgical method used to preserve function and to minimize cosmetic deformity. However, healing by secondary intention offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing would allow a rational approach to selection of patients for surgical or nonsurgical repair.
We observed 133 patients with full-thickness auricular defects (helix, antihelix, concha, pretragal and tragal area, lobule, and posterior aspect) after Mohs surgery and documented a variety of parameters affecting wound healing, including the location, depth, and size of the wound and use of antibiotics. Patients were examined at intervals and determination was made regarding cosmesis at least 6 months after surgery.
All wounds healed by secondary intention within 10 weeks. Analgesics were generally not required. Antibiotics were arbitrarily used in 13% of the patients. Three infections occurred with no permanent disfigurement.
The location of the wound in the auricular subunit is predictive of the cosmetic result. Exposed cartilage is not a contraindication for secondary intention healing. Prophylactic antibiotics are not routinely required when exposed cartilage is present. The results of secondary intention healing are often more cosmetically pleasing than those of surgical repair.
评估耳廓全层皮肤缺损的二期愈合情况。癌症手术后立即重建全层皮肤缺损是一种公认的手术方法，用于保留功能并尽量减少美容畸形。然而，二期愈合具有最佳癌症监测、简化伤口管理以及避免重建手术及其相关成本和潜在并发症等优点。准确预测伤口愈合过程将有助于合理选择手术或非手术修复的患者。
我们观察了133例Mohs手术后出现全层耳廓缺损（包括耳轮、对耳轮、耳甲、耳屏前和耳屏区域、耳垂及后侧）的患者，并记录了影响伤口愈合的各种参数，包括伤口的位置、深度和大小以及抗生素的使用情况。定期对患者进行检查，并在手术后至少6个月对美容效果进行评估。
所有伤口均在10周内通过二期愈合。一般不需要使用镇痛药。13%的患者随意使用了抗生素。发生了3例感染，未造成永久性毁容。
伤口在耳廓亚单位中的位置可预测美容效果。暴露的软骨并非二期愈合的禁忌证。存在暴露软骨时，通常不需要预防性使用抗生素。二期愈合的美容效果往往比手术修复更令人满意。
