扩张双瓣法耳郭再造术后软骨外露的临床分析及处理策略  

Clinical analysis and treatment strategy of cartilage exposure after auricular reconstruction with an expanded two flap method

作　　者：王冰清 曹彤瑜 王培洲 郭蕊 钱瑾 王悦 刘暾 章庆国 WANG Bingqing;CAO Tongyu;WANG Peizhou;GUO Rui;QIAN Jin;WANG Yue;LIU Tun;ZHANG Qingguo(The Second Center of External Ear Reconstruction,Plastic Surgery Hospital of the Chinese Academy of Medical Science,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院外耳再造二中心,北京100144

出　　处：《中国美容整形外科杂志》2022年第4期193-196,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的统计分析扩张双瓣法耳郭再造术后软骨外露的情况及病因,探讨针对耳再造术后软骨外露应采取的处理策略。方法自2018年1月至2020年12月,中国医学科学院整形外科医院外耳再造二中心行扩张双瓣法耳郭再造术853例(908侧),术后出现软骨外露32例。耳支架软骨外露的患者为病例组(32例),按照性别、年龄及侧别等变量,在非软骨外露组(821例)进行1∶1匹配抽样,匹配抽样出的同样数量的样本为对照组(32例),病例组及对照组患者均按照OMENS分类系统进行评估,分析软骨外露与HFM及OMENS分型之间的相关性。对于外露的耳支架采用颞浅筋膜瓣转移+游离皮片移植覆盖的方法进行修复。结果病例组与对照组对比发现,半侧颜面短小畸形为耳支架软骨外露的危险因素,OMENS分型中眼畸形、神经发育畸形、软组织发育畸形与耳支架软骨外露明显相关。根据软骨支架外露的情况进行修复后均得到了较好的手术效果。结论扩张双瓣法耳郭再造术后耳支架软骨外露与患者的畸形严重程度存在一定的相关性,半侧颜面短小畸形为其高危因素,颞浅筋膜瓣转移+皮片移植覆盖的方法为修复术后耳支架外露的良好手术方案。Objective To analyze the causes of cartilage exposure after auricular reconstruction with expanded two flap method and to explore corresponding management strategy.Methods Between January 2018 and December 2020,853 cases(908 affected sides)underwent auricular reconstruction with expanded two flap method in the Plastic Surgery Hospital of Chinese Academy of Medical Science.The cartilage exposure after operation occurred in 32 cases.Patients with cartilage exposure were taken as experimental group(32 cases).The control group(32 cases)was sampled from no cartilage exposure group(821 cases)by 1∶1 matched sampling according to gender,age and affected side.Both experimental group and control group were evaluated according to OMENS classification,and the correlation among occurrence of cartilage exposure,hemifacial microsomia(HFM)and OMENS classification was analyzed.All patients with cartilage exposure were repaired by superficial temporal fascia flap combined with free skin graft.Results In comparison between experimental group(32 cases)and control group(32 cases),we found that HFM was the risk factor of cartilage exposure.Orbital malformation,facial nerve dysplasia and soft tissue developmental malformation were closely associated with cartilage exposure.Good surgical outcomes were achieved after repair.Conclusion There is a certain correlation between auricular cartilage framework exposure and severity of deformity after auricular reconstruction with expanded two flap method.HFM is a high-risk factor of cartilage exposure.It is a favorable surgical method to repair the exposure of cartilage framework with superficial temporal fascia flap combined with skin graft.

关 键 词：半侧颜面短小畸形 扩张双瓣法耳郭再造术 软骨外露 颞浅筋膜 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]