“全扩张法”耳廓再造术的临床应用及适应症的探讨  

Application of and Indication for Total Expanded Flap Technique in Auricular Reconstruction

作　　者：杨巧[1] 章庆国 YANG Qiao ZHANG Qingguo(Department of Plastic Surgery, Peking University International Hospital, Beijing 102206, China Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China)

机构地区：[1]北京大学国际医院整形外科,北京102206 [2]中国医学科学院整形外科医院耳再造二中心,北京100144

出　　处：《中华耳科学杂志》2017年第3期301-305,共5页Chinese Journal of Otology

基　　金：国家自然科学基金面上项目(81571924)~~

摘　　要：目的分析与总结"全扩张法"耳廓再造术治疗先天性小耳畸形的临床经验,并探讨该方法的适应症。方法自2014年7月至2016年6月,根据患者年龄、耳后乳突区皮肤厚度及松紧度差异,选择年龄大于8岁、耳后皮肤松弛的患者共220例采用"全扩张法"耳郭再造术。手术分三期完成,一期耳后扩张器置入术,二期全耳再造术,三期再造耳修整术。结果 220例患者术后平均随访9个月,196例(89.0%)患者及家属对再造耳廓形态满意,21例(9.5%)认为再造耳廓可以接受,3例(1.4%)对再造耳形态不满意。216例(98.2%)患者胸部瘢痕均未超过4cm,最短只有1.5cm,未出现明显的胸廓畸形;扩张期相关并发症发生率3.2%,再造耳并发症发生率5.0%。结论"全扩张法"耳廓再造术是治疗先天性小耳畸形的理想术式之一。患者年龄大于8岁、耳后乳突区皮肤松弛,是"全扩张法"耳廓再造术治疗先天性小耳畸形的适应症。Objective To report experiences of auricular reconstruction with the total expanded flap technique,as well as its indications.Methods Based on the age and skin and soft tissue thickness and tightness over the mastoid,from July of 2014 to June of 2016,220 patients older than 8 years with ample retroauricular skin received auricular reconstruction using the total expanded flap technique,carried out in three stages.In the first stage,an expander was implanted,followed by total auricular reconstruction in the second stage,and trimming of the reconstructed ear in the third stage.Results During the average 9 months follow up,196 of the 220 patients（89.0%） were satisfied with their reconstructed ears,including the three dimensional position and subunit appearance;21 patients（9.5%） rated their outcomes as acceptable;and 3 patients（1.4%） were unsatisfied with their outcomes.There were no postoperative complications related to chest wall deformity or physical functions.The size of the chest wall scar was less than 4 cm in 98.2%（216/220） of the cases,with the shortest being only 1.5 cm.The rate of complications was 3.2% during skin expansion and5% for ear reconstruction.Conclusions Total expanded flap technique is an ideal method for auricular reconstruction in patients with congenital microtia.An age older than 8 years and ample retroauricular skin are indications for the technique.

关 键 词：先天性小耳畸形 耳廓再造术 全扩张法 适应症 耳后扩张皮瓣 

分 类 号：R764[医药卫生—耳鼻咽喉科]