光子脱毛联合较大体积扩张器法行外耳再造的临床研究

CLINICAL RESEARCH OF INTENSE PULSED LIGHT DEPILATION COMBINED WITH BIGGER SKIN EXPANDER IN AURICULAR RECONSTRUCTION

目的探讨采用光子脱毛联合较大体积扩张器法行外耳再造术治疗小耳畸形的临床效果。方法2000年1月~2006年1月,收治先天性单侧小耳畸形患者73例。32例采用光子脱毛联合较大体积扩张器扩张方法(新方法组)。其中男12例,女20例;年龄6~45岁。小耳畸形度6例,度20例,度6例。切取皮瓣范围9cm×5cm^11cm×6cm,筋膜瓣范围7cm×5cm^9cm×6cm。余41例采用常规扩张法进行外耳再造(传统组)。其中男13例,女28例;年龄6~42岁。小耳畸形度8例,度27例,度6例。切取皮瓣范围8cm×5cm^10cm×6cm,筋膜瓣范围7cm×5cm^9cm×6cm。对两组术中切取皮肤、术后供区瘢痕面积进行测定,比较患者及家属满意率及并发症发生率。结果患者均在二期术后6~12个月行三期再造耳修整时随访。新方法组:术后皮瓣及移植皮片均成活,切口期愈合;再造耳耳轮脚及耳轮清晰,耳轮缘无毛发生长。传统组:1例术后皮瓣远端部分坏死导致支架外露,经对症处理后愈合;余患者皮瓣及移植皮片均成活,切口期愈合;再造耳耳轮清晰,耳甲及耳舟可见,35例再造耳廓耳轮上部边缘有部分毛发。新方法组切取皮肤、瘢痕面积及患者满意率分别为18.3±1.5cm2、8.1±0.8cm2及86%,与传统组(34.2±2.6cm2、14.4±1.2cm2及71%)比较,差异有统计学意义(P<0.05)。新方法组并发症的发生率为3.1%,与传统组4.6%比较,差异无统计学意义(P>0.05)。结论光子脱毛联合较大体积扩张器法行外耳再造在未增加并发症的基础上,实现较大体积的皮肤扩张,二期再造时切取的皮肤面积小,术后瘢痕轻,再造耳无毛发,外观佳。

Objective To investigate the clinical effect of intense pulsed light depilation combined with bigger skin expander in auricular reconstruction. Methods From January 2000 to January 2006, seventy-three patients suffering congenital microtia of one side were treated. Among them, 32 patients were reconstructed by the intense pulsed light depilation combining with bigger skin expander（new method group）, and 41 patients were reconstructed by traditional auricular reconstruction method （traditional method group）. In the new method group, there were 12 males and 20 females, aging 6-45 years. The typing of congenital microtia were degree 1 in 6 cases, degree I in 20 cases and degree $ in 6cases. The size of flap ranged from 9cm×5cm to 11 cm×6cm. And the size of fascial flap ranged from 7 cm × 5 cm to 9 cm × 6 cm. In the traditional method group, there were 13 males and 28 females, aging 6-42 years. The typing of congenital microtia were degree 1 in 8 cases, degree I in 27 cases and degree Ⅲ in 6 cases. The size of flap ranged from 8 cm × 5 cm to 10 cm × 6 cm. And the size of fascial flap ranged from 7 cm × 5 cm to 9 cm× 6 cm. The skin size and scar size were measured. The complications and the satisfactory rate were compared between two groups after operation to assess the value of these methods. Results After 6-12 months of second operation, all patients were given third-stage auricular reconstruction and followed up. In the new method group, the flap and skin grafting survived and the wound healed by the first intension. The crus of helix, helix,concha and scapha could be found clearly. There was no hair on the surface of helix. In the traditional method group, the framework exposure occured in one patients because of local flap necrosis. The wound cured by the temporal superficial fascia flaps combined with split skin grafts transplantation. The other flap and skin grafting survived and the wound healed by the first intension. The helix, concha and scapha could be found, but there was some hair on the surface of 35 patients＇ helix. There were significant differences in the skin graft, scar size and the satisfactory rate between two groups （P〈0. 05）. There was no significant difference in the complications（P〉0. 05）. Conclusion There is less scar and skin grafts in this new method. And the hair can be depilated in the reconstructed auricle completely. So it can achieve more satisfactory appearance.