Medpor外耳再造术皮肤覆盖方案的临床研究  

Evaluation of soft tissue wrap protocols in alloplastic microtia reconstruction

作　　者：杨松林[1] 刘庆阳[1] 金一平[1] 丁志[1] 高云[1] 郑江红[1] 

机构地区：[1]上海交通大学附属第六人民医院整形外科,上海200233

出　　处：《中国美容医学》2006年第2期153-155,i0005,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:本文通过比较几种不同的支架外皮肤覆盖方案,探索一种手术效果稳定可靠的合成材料支架外耳再造方法。方法:48例先天性小耳畸形,应用Medpor支架行全外耳再造术,支架外软组织覆盖材料分别为单纯乳突区扩张皮肤1例、颞顶筋膜瓣加植皮25例、乳突区扩张皮瓣加颞顶筋膜瓣22例,观察比较应用不同覆盖材料耳再造后支架外露发生率、再造外耳外形轮廓、表面皮肤颜色质地。结果:临床应用48例,随访1至6年,应用单纯乳突区扩张皮瓣覆盖者1年内耳支架完全外露;应用颞顶筋膜瓣加植皮者再造耳廓外形及轮廓优良,但大部分病例再造耳廓皮瓣不同程度色素异常;应用乳突区扩张皮瓣及颞顶筋膜瓣联合覆盖者再造外耳形态及轮廓均优良,且表面皮瓣颜色质地与周围皮肤和对侧外耳皮肤一致,美容效果最佳。结论:应用乳突区扩张后皮瓣及颞顶筋膜瓣双层组织瓣的软组织覆盖方案可以满足Medpor再造外耳的外形、轮廓及皮色的需求,是一项安全稳定的手术方案,综合效果优于颞顶筋膜瓣加植皮方案,而单纯应用乳突区扩张皮瓣的方案不适用于Medpor外耳再造术。因此推荐在选用Medpor耳支架行全外耳再造治疗Ⅲ度先天性小耳畸形时,优先选用颞顶筋膜瓣联合乳突区扩张皮瓣的软组织覆盖方案。Objectives The aims of this study were to develop a surgical technique of alloplastic microtia reconstruction with a reliable soft tissue covering protocol for Medpor auricular framework. Methods Fourty-eight cases with microtia underwent alloplastic auricular reconstructions.Medpor auricular frameworks were used in all cases,but soft tissue wrap protocol were different： Expanded flap were used in 1 case, temporoparietal fascia flaps combined with overlying full-thickness skin grafts were used in 25 cases, and temporoparietal fascia flaps combined with overlying expanded flaps were used in 22 cases.Extrusion rate, profile details and skin texture of the new formed ears were observed and evaluated. Results Fourty-eight patients were followed up in 1 to 6 years postoperatively.The results showed that the whole prostheses was nearly extruded and tooked out in one case with expanded flap alone.The shap and profile details of newly formed auricles was very good in the cases with temporoparietal fascia flaps and partial thickness skin grafts,but skewbald skin was noticed in this group. The shape and profile of the reconstructed ears were excelle in the cases with expanded temporoparietal fascia flap combined with expanded skin flap.and no skewbald skin had been noticed, the color and texture were accepted as pleasing by both the patients and the doctors. Conclusion Expanded temporoparietal fascia flap combined with expanded flap formed in mastoid region is a reliable soft tissue wrap protocol for Medpor microtia aesthetic reconstruction. Application of expanded flap alone for Medpor auricular framework wrap should be avoided.

关 键 词：软组织 MEDPOR支架 外耳再造 

分 类 号：R764.1[医药卫生—耳鼻咽喉科]