背景:耳廓重建是整形和重建手术中最具挑战性的手术之一,框架材料的选择对外科医生和患者来说都是一个关键的决定。这项荟萃分析比较了使用肋软骨进行自体耳廓重建与使用多孔聚乙烯植入物进行同种异体重建的结果。
方法:使用PubMed和Embase数据库进行了文献综述,以检索2000年1月至2024年6月之间发表的文章。分析的结果包括术后并发症,如框架暴露,感染,皮肤坏死,血肿,和肥厚性疤痕,以及患者的满意度。使用R软件中的“metaprop”功能对每项选定研究的重建结果比例进行统计分析。
结果:14篇文章符合我们的纳入标准。接受聚乙烯植入物重建的组表现出更高的框架暴露率,感染,皮肤坏死,而自体重建组的血肿和肥厚性瘢痕发生率较高。在所有的并发症中,框架暴露是唯一显示两组之间有统计学显著性差异的一个(p<0.0001).在患者满意度方面,那些接受自体软骨重建的人报告了更高的满意度,尽管这一差异在荟萃分析中没有达到统计学意义(p=0.076).
结论:术后感染等并发症无统计学差异,血肿,皮肤坏死,使用自体肋软骨重建耳廓和使用聚乙烯植入物重建耳廓之间的肥厚性疤痕。然而,使用聚乙烯植入物的重建显示出明显更高的框架暴露率。
BACKGROUND: Auricle reconstruction is among the most challenging procedures in plastic and reconstructive surgery, and the choice of framework material is a critical decision for both surgeons and patients. This meta-analysis compared the outcomes of autologous auricle reconstruction using costal cartilage with those of alloplastic reconstruction using porous
polyethylene implants.
METHODS: A literature review was conducted using the PubMed and Embase databases to retrieve articles published between January 2000 and June 2024. The outcomes analyzed included postoperative complications such as framework exposure, infection, skin necrosis, hematoma, and hypertrophic scars, as well as patient satisfaction. The proportions of reconstructive outcomes from each selected study were statistically analyzed using the \"metaprop\" function in R software.
RESULTS: Fourteen articles met our inclusion criteria. The group undergoing
polyethylene implant reconstruction exhibited higher rates of framework exposure, infection, and skin necrosis, whereas the autologous reconstruction group experienced higher rates of hematoma and hypertrophic scars. Of all the complications, framework exposure was the only one to show a statistically significant difference between the two groups (p < 0.0001). In terms of patient satisfaction, those who underwent autologous cartilage reconstruction reported a higher rate of satisfaction, although this difference did not reach statistical significance in the meta-analysis (p = 0.076).
CONCLUSIONS: There is no statistically significant difference in postoperative complications such as infection, hematoma, skin necrosis, and hypertrophic scars between auricle reconstructions using autologous costal cartilage and those using
polyethylene implants. However, reconstructions with
polyethylene implants show a significantly higher rate of framework exposure.