应用Medpor支架行全扩张法耳郭再造术  

Application of Medpor framework in auricular reconstruction with expanded full skin-fascial flap

作　　者：郗敏[1] 曹玮[1] 冯幼平[1] 黄立[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院整形美容外科,湖北武汉430030

出　　处：《中国美容整形外科杂志》2016年第8期469-472,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：湖北省科学技术基金项目(2013CFB139)

摘　　要：目的探讨应用Medpor支架行全扩张法耳郭再造术的手术方法和安全性。方法自2012年以来，对12例Ⅱ°或Ⅲ°先天性小耳畸形患者，采用Medpor支架行全扩张法全耳再造术。该手术方法分3期：Ⅰ期手术于患侧乳突区深筋膜下放置70ml或80ml肾形扩张器，术后10d开始适当超量注水；Ⅱ期在扩张区域深筋膜和骨膜之间植入Medpor支架，并根据健侧耳郭调整支架形态及位置，应用扩张的筋膜皮瓣完整包裹支架；Ⅲ期去除无用残耳软骨，行耳垂转位，加深耳甲腔。结果随访6—12个月，术后再造耳郭形态良好，色泽与对侧无异，无感染、支架外露等并发症发生。12例患者中，10例患者对再造耳郭满意或比较满意；1例患者术后颅耳角缩小；另1例患者对术后头皮瘢痕不满意。结论应用Medpor支架行全扩张法全耳再造术，手术操作简便快捷，术后再造耳郭形态良好，无感染、支架外露等并发症，是一种值得深入研究和尝试的术式，其远期疗效及安全性有待进一步观察。Objective To investigate the operative method and safety of the Medpor framework in auricular reconstruction with expanded full skin-fascial flap. Methods Since 2012,12 congenital microtiacases were treated using the Medpor framework and expanded full skin-fascial flap. This method for ear reconstruction contained three stages. A 70 or 80 ml kidney-shaped skin expander was inserted under the deep fascia of the mastoid region during the first stage and appropriate overnjection of saline into the expander was performed at 10 days postoperatively. The Medpor framework was inserted between the fascial skin flap and peritoneum at the mastoid region at the second stage, the shape and position of the framework were adjusted according to the contralateral ear, and then the expanded fasciocutaneous flap was used to covere the whole surface of the framework; After removal of the unwanted vestigial cartilages, the auricular lobule was transferred to deepen the auricular concha at the third stage. Results During 6 to 12 months follow-up, 10 cases were satisfied with the good shapes and similar color to the normal side and 2 cases were dissatisfied with the reconstructed ear because of small auriculocephalic angle and scalp scar. Few complications occurred, such as infection or framework exposure. Conclusi on The surgical technique in ear reconstruction using the method of full skin expansion with a Medper framework is simple and reliable. This method provides satisfactory clinical results and reduces complications to a minimum. It is worthy of clinical application and its long-term efficacy and safety needs further study.

关 键 词：小耳畸形 全扩张法全耳再造术 MEDPOR支架 耳郭 支架外露 

分 类 号：R764.9[医药卫生—耳鼻咽喉科] R622[医药卫生—临床医学]