全扩张法外耳再造术在52例先天性小耳畸形患者中的应用体会  

Experience of external ear reconstruction by applying completely expanded retroauricular flap in 52 patients with congenital microtia

作　　者：杨静 贾东辉 乔嘉璐 彭晰明 陈相儒 杨艳清 YANG Jing;JIA Donghui;QIAO Jialu;PENG Ximing;CHEN Xiangru;YANG Yanqing(School of Medicine,Jianghan University,Wuhan 430056,China)

机构地区：[1]江汉大学医学部,湖北武汉430056 [2]武汉市第三医院/武汉大学同仁医院整形外科,湖北武汉430060

出　　处：《中国美容整形外科杂志》2024年第4期210-212,232,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的总结采用大容量扩张器全扩张法外耳再造术对先天性小耳畸形患者的临床应用体会。方法回顾性分析自2013年9月至2022年8月,武汉市第三医院整形外科收治的52例先天性小耳畸形患者,手术分3期进行,一期行残耳耳后皮肤软组织扩张器置入术,充分扩张耳后皮肤;二期手术取出扩张器,并取右侧肋软骨雕刻耳软骨支架,埋植于扩张后皮瓣下,得到立体耳形态;三期手术进行再造耳局部修整,使整体效果更加接近于正常耳。结果52例患者术后获随访6~36个月,46例再造耳耳部结构清晰立体,与健耳对称性好,软骨支架无移位变形。4例颅耳角变浅,三期行全厚皮片移植加深颅耳角;2例支架吸收,再造耳形态欠佳。结论对于先天性小耳畸形患者采用全扩张法外耳再造术,再造耳结构清晰立体,皮肤色泽质地均匀良好,并发症较少,解决了传统扩张法需要植皮的弊端,值得临床推广应用。Objective To summarize the clinical experience of external ear reconstruction with large-capacity dilator in patients with congenital microtia.Methods The surgery was carried out in three stages.In the first stage,the soft tissue expander of post-auricular skin was placed in the residual ear,and the post-auricular skin was fully expanded.In the second stage,the expander was removed and the right side of rib cartilage was taken to sculpture the ear cartilage scaffolding,which was embedded under the expanded flap to obtain a three-dimensional ear shape.Finally,the reconstructed ear was partially trimmed,so that the reconstructed ear was close to the normal ear.Results The 52 patients operated in Wuhan Third Hospital from 2013 to 2022 were followed up for 6 months to 3 years.46 patients of reconstructed ear were satisfied with clear and three-dimensional ear structure,good symmetry with the healthy ear,and no displacement or deformation of cartilage scaffolding,and 4 patients had shallow cranio-auricular angles,and full-thickness skin grafts were performed to deepen the cranio-auricular angle in stageⅢ.In 2 cases,the scaffolds were absorbed,and the reconstructed ears were poorly shaped.Conclusion For patients with congenital microtia,applying completely expanded retroauricular flap method of external ear reconstruction can provide a clear and three-dimensional structure of the reconstructed ear,with good uniformity of complexion and texture,and fewer complications,solving the drawbacks of the traditional expansion method that requires skin grafting and reducing the possibility of scarring.

关 键 词：小耳畸形 全耳郭再造术 皮肤软组织扩张器 颅耳角 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]