小耳畸形的“二期法”耳廓再造术  

"Two-stage" Ear Reconstruction for Microtia

作　　者：魏建军 潘博 于晓波 刘磊 赵延勇 林琳 庄洪兴 蒋海越 

机构地区：[1]中国医学科学院整形外科医院外耳再造中心,北京市100144

出　　处：《组织工程与重建外科杂志》2010年第5期276-278,共3页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：卫生部临床学科重点项目(2004468);国家自然科学基金资助项目(30500290;30950032)

摘　　要：目的探讨"二期法"行耳廓再造术的临床应用。方法第1期手术:切取右侧第6～8肋软骨,制成具有三层结构的自体肋软骨支架;应用"双瓣"技术,以残耳根部为蒂,将后方乳突区无毛发的皮肤掀起,形成皮瓣,耳后筋膜瓣的范围扩大至发际线内3.5～4 cm,呈半圆形。将肋软骨支架移植于"双瓣"之间,进行耳廓再造。第2期:利用剩余的残耳组织,重建耳轮脚、耳屏和耳甲腔等耳廓亚解剖结构。将残耳上半部制成"V"形耳轮脚皮瓣;将中部残耳组织制成半圆形耳屏皮瓣。同时将上半部残耳软骨雕刻成圆锥状,与再造耳的耳轮末端缝合固定,耳轮脚皮瓣转位覆盖,形成耳轮脚;将中部残耳软骨修剪成半圆形,用耳屏皮瓣包裹再造耳屏。切除耳甲内多余组织,进行加深,创面植皮覆盖。结果 2007年至2010年,采用"二期法"实施耳廓再造71例。经过0.5～3年随访观察,再造耳位置适当,大小与健侧基本一致;皮肤颜色与面部接近,随时间延长皮肤感觉逐渐恢复;支架无吸收及变形,再造耳廓的立体结构良好、外形自然;颅耳角与对侧相似,耳后瘢痕不明显。结论 "二期法"耳廓再造术简便易行,并发症少,易于推广应用。Objective To explore the technique of Two-stage ear reconstruction for microtia.Methods Ear reconstruction was done using the ＂two-flap＂ technique and autogenous rib cartilage framework in the first stage.Almost all fine structures of ear,such as the crus,the tragus and the conchal cavity were reconstructed in the second stage.Results Seventy one patients of microtia underwent auricular reconstruction mainly by Two-stage ear reconstruction.All patients were followed up for 6 months-3 years after surgery.The colour of the reconstructed ears was in harmony with the facial skin;cartilage framework had no absorption and deformation.The reconstructed ears had excellent and three-dimensional contour and the cranio-auricular angle of the reconstructed ears bear strong resemblances to the opposite ears.Conclusion Two-stage ear reconstruction was a simple method with few complications and could be easily mastered.

关 键 词：先天性小耳畸形 耳廓再造 耳前皮瓣 筋膜瓣 肋软骨支架 

分 类 号：R622[医药卫生—整形外科]