扩展耳后扩张皮瓣法耳廓再造术  

Total auricular reconstruction using extended retroauricular flap and tissue expansion

作　　者：李川 蒋海越 李惠斌 于晓波 张晔 杨美蓉 孙中泱 潘博 

机构地区：[1]中国医学科学院整形外科医院耳整形一中心,北京100144 [2]山东省临沂市人民医院烧伤整形科

出　　处：《中华整形外科杂志》2017年第4期247-252,共6页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院医学与健康科技创新工程经费资助（2016-12M-1-002）

摘　　要：目的对经典扩张法耳廓再造术进行改良，并探讨其临床应用效果。 方法对150例小耳畸形患者的健侧耳廓和扩张皮瓣进行三维测量，参照测量结果选择82例患者行扩展耳后扩张皮瓣全耳再造术。一期手术于耳后皮下埋置50 ml肾形扩张器，注水至65 ml左右继续维持扩张4周左右。二期手术取出扩张器，并于扩张皮瓣外4～5 cm的头皮下分离，形成由中间扩张皮肤和周围非扩张皮肤组成的复合皮瓣，完整包裹三维立体肋软骨支架，进行耳廓再造。 结果术后皮瓣血液供应和静脉回流较好，无明显的肿胀，仅2例在术后48 h内出现耳轮皮肤坏死，皮肤缺损较少者可直接清创缝合，缺损大者需应用耳后筋膜瓣和游离植皮的方式进行修复。术后随访4～15个月，平均6.7个月，双侧耳廓大小和位置基本对称，形态结构清晰，耳轮形态柔和不臃肿，颅耳沟清晰，颅耳角与对侧一致。再造耳前后两面颜色一致，无色差。耳后发际线处及肋软骨采取切口瘢痕不明显。 结论扩展耳后扩张皮瓣技术再造耳廓，无需采用耳后筋膜皮瓣和皮片移植，方法简单，效果较好。ObjectiveTo investigate the modification of the classic techniques of total auricle reconstruction with skin expansion, and its clinical application.MethodsWe performed three-dimensional measurement of the normal auricle and the expanded flap on 150 microtia patients. According to the data, we carried out total auricle reconstruction using extended postauricle expanded flap techniques for 82 patients of the group. Firstly, a 50 ml kidney-shaped expander was inserted subcutaneously in the mastoid region. Approximately 65 ml saline was injected in about 30 days, and expansion was kept without injection for another 30 days. In the second stage, we removed the expander and dissected the scalp 4-5 cm around the expanded skin, to make a composite flap consisted of expanded skin and extend scalp. Then we used the flap to encapsulate the three-dimensional rib cartilage framework to accomplish total auricle reconstruction.ResultsThe blood supply and venous drainage of the flap was good. No obvious postoperative flap swelling was observed. Only 2 cases of helix skin necrosis happened in 48 hours after operation. Small area of skin defect was treated by debridement and suture, while larger area of skin defect was repaired with postauricular fascia flap and free skin graft. Postoperative follow-up period was 4-15 months, about 6.7 months in average. Bilateral ear size and position were similar with clear structures and shapes. Helix seemed more slim, auriculocephalic sulcus was obvious, auriculocephalic angle was similar to the other side. There was no color abberration between the front and back side of reconstructed ear. Scars of retroauricular hairline incision and costal cartilage harvesting incision were not obvious.ConclusionsThe novel surgical techniques is reasonable and simple without fascia flap or skin graft, which is worthy of application by more plastic surgeons.

关 键 词：小耳畸形 皮肤软组织扩张术 耳廓再造术 

分 类 号：R622[医药卫生—整形外科] R764.9[医药卫生—外科学]