扩张法成人耳再造术中肋软骨使用技巧  

Skills used in the costal cartilage expansion method of adult ear reconstruction

作　　者：张颖佳[1] 郭群[1] 王继华[1] 杨云[1] 汤婷[1] 何永静[1] 杨蔚琪[1] 张伯俊[1] 李姝蓉 ZHANG Ying-jia;GUO Qun;WANG Ji-hua;YANG Yun;TANG Ting;HE Yong-jing;YANG Wei-qi;ZHANG Bo-jun;LI Shu-rong(Department of Plastic Surgery,The Second Hospital Affiliated to Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院整形外科,云南昆明650101

出　　处：《中国美容整形外科杂志》2018年第8期452-454,461,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨扩张法成人小耳畸形耳再造手术中肋软骨的使用和支架组合技巧。方法选取自2008年8月至2018年5月就诊的先天性小耳畸形成年患者共34例,耳郭畸形均为Ⅱ型或Ⅲ型,所有患者均采用耳后皮肤扩张法肋软骨耳再造手术。一期手术常规采用残耳耳后皮肤置入扩张器,注水扩张;二期手术仅切取2段肋软骨(第6、7肋)进行雕刻及组合,形成3层三维立体耳郭支架结构进行耳再造;三期进行耳垂转位及耳甲腔加深。结果所有患者术后获随访3~24个月。颅耳沟存在,角度适中,耳郭位置正常,耳轮、对耳轮及三角窝结构显现,患者及家属对外观表示满意。结论对成年人小耳畸形耳再造患者采取合理的肋软骨切取方法,高效的利用及精心的拼接技巧,仅用2段肋软骨就能得到术后满意的外观。Objective To explore the combination of costal cartilage in creation of a scaffold in the reconstruction of adult auricles with the expansion method. Methods From August 2008 to May 2018, 34 adult patients admitted to our department with congenital microtia were selected. The classification of malformations was typeⅡand Ⅲ. The retroauricular skin expansion method and costal cartilage transplantation for auricle reconstruction were performed for all patients. In the first stage of the operation, the skin expander was routinely implanted at the post aurem of the residual ear, and water was injected for expansion. In the second stage, only 2 independent segments of costal cartilage（6, 7） were harvested, sculptured, and combined. A three-layer, three-dimensional costal cartilage framework was used for ear reconstruction. During the third stage of the operation, the earlobe was transposed and the cavum conchae deepened. Results The follow-up period ranged from 3 months to 2 years. After operation, the cranial ear sulcus was visible, the angle was moderate, and the auricle position was normal. The structure of the helix, anthelix, and fossae triangularis auriculae appeared good. Patients and their family members were satisfied with the postoperative appearance. Conclusion For adult patients with congenital microtia undergoing auricle reconstruction, use of the rational costal cartilage cutting method combined with highly efficient sculpture and the costal cartilage splicing technique can achieve a satisfactory postoperative appearance with only 2 segments of costal cartilage.

关 键 词：耳再造 皮肤扩张法 肋软骨 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]