完全应用扩张皮瓣包裹再造耳软骨支架的临床疗效分析  

Analysis of clinical efficacy in using expanded retroauricular flap to fully cover reconstructed cartilage scaffold

作　　者：张振宇[1] 刘睿奇 唐军[1] 陈俊杰[1] 岑瑛[1] 李正勇[1] Zhang Zhenyu;Liu Ruiqi;Tang Jun;Chen Junjie;Cen Ying;Li Zhengyong(Department of Cosmetic Plastic and Burn Surgery,Vest China Hospital,Siehuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院美容整形烧伤外科,成都610041

出　　处：《中华整形外科杂志》2018年第7期529-533,共5页Chinese Journal of Plastic Surgery

基　　金：四川省科技厅应用基础研究项目（2017JY0335,2017JY0250）

摘　　要：目的探讨完全使用扩张耳后皮瓣对再造耳软骨支架进行包裹的临床疗效。方法应用组织扩张器法行全耳再造术治疗53例先天性小耳畸形患者，一期手术于耳后置入50ml。肾形扩张器，超量扩张至70ml并静置4周。二期手术完全使用扩张后皮瓣包裹耳后筋膜瓣及再造的耳软骨支架，完成耳廓再造术，术后随访并观察疗效。结果所有手术均顺利完成，术后切口均一期愈合，耳后皮瓣血运良好，软骨支架完全存活，无感染发生。患者均获1-12个月随访，再造的外耳轮廓清晰、耳支架挺立无塌陷，耳高度满意，双侧耳基本对称，颅耳角锐利平整。再造耳前后皮肤颜色一致，各切口无明显瘢痕增生。结论完全应用扩张耳后皮瓣包裹耳软骨支架，可操作性强，避免耳后植皮，可以较好地治疗小耳畸形。Objective In order to achieve superior aesthetic outcomes of reconstructed ear, analyze and summarize clinical therapeutic effect in completely applying expanded retroauricular flap to encapsulate cartilage scaffold in total auricular reconstruction. Methods From January 2016 to October 2017, fifty-three congenital microtia patients were treated. A kidney-shaped tissue expander with 50 ml capacity was embedded under retroauricular skin in the first-stage. After excessive expansion to 70 ml and remaining stable for 4 weeks, secondary operation was performed to completely encapsulate cartilage scaffold with expanded retroauricular skin. Postoperative follow-up was carried out on a routine basis. Results All patients had undergone operations successfully with primary healing of incision. Blood supply of the retroauricular flaps was excellent, and cartilage scaffolds totally survived with no infection and absorption. Satisfactory aesthetic outcome along with clear structure, reasonable symmetry and suitable auriculocephalic angle was acquired in all cases. No color aberration was observed between the front and back side of reconstructed ear. Scars of retroauricular incisions and costal cartilage harvesting incisions were unconspicuous. Conclusions Only using expansive retroauricular flap to fully cover reconstructed cartilage scaffold is reasonable and simple without skin grafting, which is worthy of more application in microtia treatment.

关 键 词：小耳畸形 外科皮瓣 软组织扩张器 耳廓再造术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]