三种全耳再造术临床分析

Clinical analysis of three kinds of ear reconstruction

目的观察三种全耳再造术的疗效 ,探讨较理想的耳再造方法。方法 77例耳部缺损患者 ,分别行分期法Tanzer’s耳再造术 (未经皮肤扩张组 ,5 2例 )、扩张器扩张乳突区皮肤后耳再造术 (皮肤扩张组 ,15例 )和多孔高密度聚乙烯 (Medpor)支架颞浅筋膜瓣加植皮一期耳再造术 (Medpor耳支架组 ,10例 )。 结果未经皮肤扩张组中有 2例部分皮肤血运障碍需再行处理 ,其余外形良好 ,轮廓清晰。皮肤扩张组外形较满意 ,轮廓较清晰。Medpor耳支架组有 3例支架外露经皮瓣修复愈合 ,轮廓较清楚 ,但耳颅角不明显。结论以肋软骨作支架的分期耳再造术是较可靠的治疗方法。扩张皮肤后耳再造术提供了充足的皮肤也较为理想。Medpor支架耳再造术易发生支架外露 ,常需再次植皮或皮瓣修复。

Objective Three kinds of ear reconstruction were compared with each other to find the better one. Methods Tanzer's reconstruction with autogenous rib cartilage framework in stages was applied in 52 cases. In 15 cases, the skin of the auricular area was extended, by wrapping the cartilage framework together with skin graft at the mastoid area. In 10 cases, Medpor auricular framework was wrapped by the superficial temporal fascia covered with skin graft. Results Fifty-two cases got good contour with sharp outlines (blood supply deficiency of the skin flap took place in 2 cases and was treated with further procedures). Fifteen skin extension cases also got satisfactory contour with sharp outlines. The frameworks broke out in 3 out of 10 Medpor framework cases and were recovered by local skin flaps. The outline was sharp. Conclusion Tanzer's reconstruction with cartilage framework in stages is classical and veliable. Skin extension presents plenty of good skin cover. Medpor framework reconstruction may result in framework broke out, and needs further reconstruction by local skin flaps.