Application of Human Fibrin Sealant in Microtia Reconstruction

在小耳症重建手術中使用人類血纖維蛋白密封劑

周邦昀(Pang-Yun Chou) ； 陳潤茺(Zung-Chung Chen) ； 許聰政(Chung-Chen Hsu) ； 陳國鼎(Kuo-Ting Chen) ； 羅綸洲(Jun-Jo Lo) ； 王祥亞(Hsiang-Ya Wang)

《臺灣整形外科醫學會雜誌》 21卷4期 (2012/12) Pp. 301-307

https://doi.org/10.7096/TJTSPS.201212.0301

摘要

背景：小耳症重建的基本原則在於重建一個和正常耳朵外型相近的耳廓。目的及目標：在於證實在第一階段小耳重建手術中使用人類血纖維蛋白密封劑（human Fibrin Sealant），而不使用支撐縫線或是引流系統，仍然能夠獲得和正常耳朵外型相近的耳廓。材料及方法：在小耳症重建第一階段手術中，我們使用人類血纖維蛋白密封劑，在將雕刻過後的3-D立體軟骨耳廓放進預先準備的空間中，將人類血纖維蛋白密封劑放進3-D立體軟骨耳廓及皮瓣中間，我們將紗布捲起放置在重建耳廓的迴旋處加壓，最後再用一片3M的透明膠帶（Tegaderm）將整個重建的耳廓及加壓紗布密封起來，重建的耳廓外型並沒有再靠其他外力加壓來維持。結果：我們在8個小耳症重建手術中使用這種方法，所有病人的結果都能夠持久並且令人滿意。結論：使用這種方法和比較使用其他方法的優點在於：簡單，易於使用並且在術後不需使用縫線固定或是引流系統，所以能夠讓病人感覺到更舒服並且可以減少使用縫線固定或是引流系統引起的併發症。

並列摘要

Background: The fundamental principle of microtia reconstruction is to create an auricle with an appearance as close as possible to that of a normal auricle. Aim and Objectives: To improve that the use of human fibrin sealant during the first stage auricular reconstruction can attain an accentuated contour of the reconstructed auricle without resorting to placement of a drainage system or bolster suture. Materials and Methods: In the first stage operation in microtia reconstruction, we use human fibrin sealant (Tissucol Duo Quick) after insertion of the three-dimension costal cartilage (3-D frame) under the skin pocket and wound closure. The human fibrin sealant was placed to the space between the 3- D frame and skin flap. The contour of the reconstructed auricle was retained without the application of any external force. A wide 3M Tegaderm was used to completely seal the reconstructed auricle and rolled gauze was placed in the convoluted areas of the reconstructed auricle. Results: We have applied this maneuver to eight consecutive reconstruction patients and the overall results have been consistent and more satisfactory. There are no major postoperative complications encountered. Conclusion: The benefits of this maneuver when compared with the others are: simple, easy to apply and no need to use suture or another suction devices postoperatively, therefore makes the patients more comfortable and theoretically reduces the complications associated with bolster suturing and continuous suction drainage.

並列關鍵字

human fibrin sealant ； micotia reconstruction ； autologous rib graft