双扩张器重叠扩张无需植皮的全耳成形术  

Auricular reconstruction with overlapping tissue

作　　者：刘嘉锋[1] 孙家明[1] 张一鸣[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院整形外科,武汉430022

出　　处：《中华整形外科杂志》2009年第5期347-350,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨一期采用双扩张器重叠扩张，二期无需植皮进行全耳成形术的方法，并总结其优缺点及适应证。方法对6例先天性小耳畸形患者，采用一期在耳后区上、下重叠各埋置1个扩张器，常规注水扩张。二期取出扩张器，以自体肋软骨或Medpor材料作为支架，筋膜瓣包裹支架，设计上部扩张皮瓣，覆盖支架前侧及后侧上部；下部扩张皮瓣覆盖支架后侧下部；残余扩张皮瓣，向下推进转移后覆盖耳后颅侧壁创面。同时采用传统扩张法行全耳成形术13例作为对照。结果所有患者术中均无需另取皮片移植，术后所造外耳轮廓清晰，形状逼真，无感染及支架外露等并发症发生，仅1例耳后皮瓣远端约0．5cm×0．5cm表皮坏死，经换药后愈合。术后随访3—6个月，采用双扩张器重叠扩张组患者，利用胸部切取肋软骨切口作为皮片的供区切口瘢痕明显较单扩张器传统扩张法为小（P〈0．05）；并发症的发生率明显低于单扩张器传统扩张法组（P〈0．01），患者的满意率也高于单扩张器传统扩张法组（P〈0．05），但在成形的外耳耳轮上后部可见少许毛发生长。结论双扩张器重叠扩张法可以扩张出足够的皮肤组织，在二期耳成形术时，通过精心合理设计扩张皮瓣覆盖耳后创面，无需植皮，切取软骨部的供区瘢痕明显减小，支架外露及感染等并发症的发生率也明显降低。Objective To investigate a method of auricular reconstruction with overlapping tissue expansion techniques and without skin graft. Methods Two tissue expanders were implanted subcutaneously at the mastoid. 6 patients with microtia（overlapping group）were treated. After completion of skin expansion, the expanders were removed. The autologous rib cartilage or Medpor scaffolds were implanted. The flap A made by the upper expanded flap was used to cover the upper part of the front and the back of the framework. The flap B made by lower expanded flap was transplanted to cover the lower part of the back of frameworks. The remaining expanded skin was designed to cover the postauricular wound. The other thirteen microtia patients who treated by the traditional auricular reconstruction were selected as control（ traditional group）. Results Skin graft was not necessary in the patients of overlapping groups. The appearance of the reconstructed ear Was very satisfactory. Epidermal necrosis of 0.5 cm× 0.5 cm happened at the distal end of postaurieular flap in one ease. All the other cases had no complication of infection or framework exposure. The patients were followed up for 3 - 6 months. Compared with the traditional group, the scar in the costal donor site was inconspicuous in overlapping group（ P 〈 0.05）. The complication rate was lower and satisfactory rate was higher in overlapping group （P 〈 0.01 and P 〈 0.05）. But there was hair growth in the helix of reconstructed ear in overlapping group. Conclusions The overlapping expansion can provide enough skin for ear reconstruction. The skin graft is not necessary, resulting less donor site scar and low complications.

关 键 词：小耳畸形 软组织扩张术 耳成形术 

分 类 号：R764[医药卫生—耳鼻咽喉科]