- 期刊
Dermoplasty for Recurrent Anterior Nasal Septal Bleeding-A Report of Four Cases
植皮術應用於反覆性鼻中隔前部出血－四例報告
摘要
鼻出血為耳鼻喉科急診常見的疾病之一，對於反覆嚴重出血難以控制的病患，曾有許多文獻指出鼻中隔植皮術成功的減少鼻出血次數及嚴重度。過去十年來，我們對四位謹慎挑選、反覆性鼻中隔前部出血的病患進行鼻中隔植皮術。手術過程程先由大腿取下裂層植皮並且剪裁成適當大小，然後用刮匙移除鼻中隔病變處黏膜，再將裂層植皮縫合固定於鼻中隔病變處。為了增加裂層植皮成功率，其中有三位病患利用矽質片覆蓋於裂層植皮上，並用縫線固定二週。有兩位病患因為裂層植皮未存活或新的鼻中隔糜爛產生，而再度接受手術。術後所有病患鼻出血的頻率及嚴重度顯著減低，醫療的需求次數也明顯減少。因此，我們的經驗顯示鼻中隔植皮術對於鼻中隔前部糜爛所造成的反覆嚴重鼻出血有明顯助益。
並列摘要
Epistaxis is a common disorder in otolaryngological emergency. For recurrent severe epistaxis not responding to conservative treatment, septal dermoplasty has been reported to effectively reduce the frequency and severity of bleeding. During the past 10 years, we performed septal dermoplasty in four carefully selected patients not diagnosed with definite hereditary hemorrhagic telangiectasia (HHT) but with recurrent severe epistaxis from the anterior nasal septum. Each operation began with harvesting split thickness skin graft from the thigh and trimming the graft to the appropriate size (about 3×3cm for each side of the septum). Then the graft was sutured onto the septum after curetting the diseased mucosa. To improve the survival of the skin graft, silastic sheets were applied on the graft and fixed in the through and through suture fashion in three patients for 2 weeks. Two patients underwent revision surgery because of graft failure or new septal erosions. Postoperatively, the frequency and severity of epistaxis decreased dramatically in all patients. The demand for emergent treatment also decreased significantly. Thus, our experiences revealed that limited septal dermoplasty is beneficial in carefully selected patients with recurrent severe epistaxis from anterior septal erosions.