2. Under local anesthesia, cut the skin around the scar and completely remove the scar on the surface of the eardrum to stop bleeding. Repair of auricle wound with full-thickness clavicle skin graft or middle-thickness upper arm skin graft. The periphery of the skin graft was sutured intermittently, leaving a long line, which was pressed and fixed by pressure. Unpacking on 10 day after operation, and taking out stitches on 12 day. Note: the skin graft area should be large enough and the tension should be moderate to avoid being too nervous. Postoperative skin graft contraction will affect the surgical effect, but it should also be avoided that skin graft is too loose to affect the survival. After stitches are removed, apply scar softening paste on the skin graft and press the skin graft frequently to soften the skin graft and prevent scar formation at the cutting edge. If there are signs of scar hyperplasia, Corning Ke Tong -A can also be injected into the incisal margin.
3. The application of local scar flap of helix tissue flap is a common method to treat scar hyperplasia and keloid of outer helix.
(1) indications: focal hypertrophic scar or keloid, which is ineffective without surgical treatment and is not suitable for other surgical methods; Scar hyperplasia area is less than 5cmX5cm.
(2) Contraindications: it has been diagnosed as scar constitution and is in the active stage of scar hyperplasia; Large scar hyperplasia area; Surgery has general contraindications.
(3) Operation method: The operation can be performed under local infiltration anesthesia, and the skin and subcutaneous tissue are cut on one side of the right helix keloid, and then the normal tissue layer under the scar is rapidly separated from the normal tissue layer on the other side. Make 2 ~ 3 longitudinal incisions on the overturned whip mark, remove the fibrous tissue proliferated in the keloid, and keep the fibrous tissue layer of scar epidermis and 4 ~ 5 mm under the epidermis to form a soft scar flap suitable for the wound size. Check whether the bleeding of scar flap is active, suture the wound directly with 3-0 silk thread without tension, and trim the redundant tissue properly. Cover the wound with conventional medical gauze and wrap the wound with sterile gauze. The stitches were removed 7 ~ 10 days after operation. Key points of successful operation: the incision should be parallel to the long axis of the external spiral scar tissue, the aspect ratio of the scar flap should be less than 1: 0.5, the scar tissue should be separated from the normal subcutaneous tissue layer, and care should be taken not to damage the subcutaneous tissue of the pedicle when cutting off the fibrous tissue proliferated under the epidermis. The width of scar flap should be based on tension-free coverage of spiral wound, and excess tissue should be removed.
(4) Surgical effect: In the past, local scar excision and direct suture, local scar tissue excision and medium-thick skin graft covering the wound, corticosteroid injection in local scar tissue and other non-surgical methods were mostly used to treat hypertrophic scar or keloid of helix. These methods are more likely to cause postoperative pathological scar recurrence in clinical application. Since 1995, Li Yangqun et al. have treated 10 cases of hypertrophic scar and keloid in the helix, including 18 external auricles, aged between16 and 34 years. The main cause of injury is flame burn, including gasoline burn and alcohol burn. Follow-up for half a year after operation 1 time, including whether the patient has strange itching symptoms, whether the appearance has scar hyperplasia of helix incision, and whether the local tissue hardness is increased by palpation. Follow-up for 7 years, no recurrence, good results. The number of cases in this group is small, and the tissue flap reflecting the local scar of helix is a better method to treat the scar hyperplasia and keloid of outer helix. However, attention should still be paid to the follow-up of postoperative scar hyperplasia, and local steroid injection should be given after 1 month if necessary to prevent scar hyperplasia.