耳后扩张皮瓣破溃耳廓再造的临床研究  

Ear reconstruction after rupture of postauricular expanded flap

作　　者：胡守舵 何乐人[2] 赵延勇[2] 蒋海越[2] 杨庆华[2] 庄洪兴[2] 

机构地区：[1]北京市中西医结合医院整形外科,北京100039 [2]中国医学科学院整形外科医院

出　　处：《中华整形外科杂志》2012年第5期328-331,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨耳后扩张皮瓣破溃时耳廓再造的处理方法。方法将破溃耳后扩张皮瓣分为4度，对Ⅰ、Ⅱ度破溃患者，急诊行耳廓再造、自体肋软骨支架移植术。对Ⅲ度破溃患者，先行局部及全身治疗，待局部红肿消退后行耳廓再造术。对Ⅳ度破溃患者，先行耳后扩张皮瓣舒平术，待3个月以后再行耳廓再造术。结果本组67例，Ⅰ、Ⅱ度破溃者43例，Ⅲ度17例，Ⅳ度7例。应用自体肋软骨耳廓支架移植耳廓再造43例；应用medpor耳廓支架移植耳廓再造者17例；先行耳后扩张皮瓣舒平、然后行自体肋软骨耳廓支架移植耳廓再造术的有7例。所有患者均一期痊愈出院。出现并发症4例，约占7％，但是均经过及时有效的处理，未影响最终术后效果，总体效果满意。结论对于外耳再造时耳后扩张皮瓣破溃进行合适的分度和采用相应的处理方法，可获得良好的效果。Objective To summarize the principles of ear reconstruction after rupture of postauricular expanded flap. Methods The rupture of the postaurieular expanded flap was graded as Ⅰ- Ⅳ degree. For flap rupture of I and Ⅱ degree, the ear reconstruction was performed immediately with autogenous cartilage framework. For flap rupture of III degree, topical and systemic treatment should be done to relieve the redness and swelling. Then the ear reconstruction was performed. For flap rupture of Ⅳ degree, the expanded postaurieular flap was smoothened. Ear reconstruction was performed 3 months later. Results There were 67 cases with flap rupture, including 43 cases as Ⅰ and Ⅱ degree, 17 cases as Ⅲ degree and 7 cases as Ⅳ degree. Ear reconstruction with autogenous cartilage framework was performed in 43 cases, with Medpor framework in 17 cases. Flap smoothening and secondary ear reconstruction with autogenous cartilage framework was performed in 7 cases. The results were satisfactory with complications in 4 cases （7%）, which resolved after treatment. Primary healing was achieved in all the patients. Conclusions Good result could be achieved in ear reconstruction, even after flap rupture. Proper treatment should be adopted according to the ruoture degree.

关 键 词：耳廓再造术 扩张皮瓣 破溃 

分 类 号：R764[医药卫生—耳鼻咽喉科]