耳后皮瓣在外耳部分缺损的亚单位分区精准修复  

Precise regional reconstruction of segmental ear defect with postauricular skin flap

作　　者：张林[1] 赵宇[1] 李小静[1] 丁浩[1] 王帮河[1] 朱飞[1] 宁金龙[1] 汪春兰[1] Zhang Lin;Zhao Yu;Li Xiaojing;Ding Hao;Wang Banghe;Zhu Fei;Nin Jinlong;Wang Chunlan(Department of Plastic Surgery,First Affiliated Hospital of Anhui Medical Hospital,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院整形外科,合肥230022

出　　处：《中华整形外科杂志》2018年第8期625-629,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨耳后皮瓣在外耳部分缺损亚单位分区修复的方法选择和效果。方法25例耳缺损按部位分5区，对于1、2区缺损，利用以耳上极为蒂的耳后乳突区皮瓣携同侧或对侧耳甲软骨一期转移修复；3区缺损则利用蒂在后的耳后皮瓣结合耳甲软骨或肋软骨条移植，二期修复；4区则软骨开窗将耳后皮瓣穿引至前方覆盖修复；5区均利用耳后延及乳突区或颈部双叶瓣或菱伯格皮瓣折叠修复；3例耳再造术后的软骨外露以颞浅筋膜瓣包盖加植皮修复。结果除9例需二期修整或断蒂外，余均一期完成。3例颞浅筋膜植皮者瘢痕色差较明显，1例隧道移植耳甲腔患者表皮部分糜烂，换药后愈合。结论对外耳各亚单位缺损，若耳周皮肤完好，耳后乳突区皮瓣是首选的修复方法，色泽质地匹配，可根据血供和分区设计不同形式、联合耳甲软骨或肋软骨一期或二期完成。颞浅筋膜瓣用于修复耳再造软骨外露等。Objective To explore the method and result of repairing segmental ear defect with postauricular skin flap according to different region. Methods 25 partial ear defects were divided into 5 regions. The cases with defect in 1 and 2nd regions were treated by postauricular flap combined with ipsilateral eonchal cartilage graft in one stage; Cases in the 3rd regions were repaired with the posterior pedicled flap combined with conchal or rib cartilage graft in two stages; According to the defect in 4th region,post-auricular skin flap was transplanted anteriorly to repair; The temporal faseial flap and skin graft were used for the 3 cases with post-operative cartilage exposure. Results All flaps survived with good shape except one case with partial epidermal necrosis and 3 cases deep color after the temporal fascial flap and skin graft. 9 cases that needed second operation. Conclusions The postauricular flap is a preferred alternative method in case periauricular skin is in fact, which yields closer tissue match, color, and texture. It is safe and effective for the correction of segmental ear defect with satisfied shape. The temporal fascial flap can be regarded as the last alternatives.

关 键 词：耳缺损 外科皮瓣 修复外科手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]