“耳屏瓣”联合“Z”改型法在小儿先天性耳屏畸形手术矫正中的应用及文献回顾

"Tragus flap"combined with"Z"modification method in the surgical correction of congenital tragal deformity in children and literature review

目的:探讨“耳屏瓣”联合“Z”改型法在小儿先天性耳屏畸形手术矫正中的临床效果。方法:回顾性总结2016年6月-2021年6月于南京医科大学附属儿童医院住院手术的36例小儿先天性耳屏畸形患儿的临床资料,其中30例(35耳)先天性耳屏畸形患儿存在自然的“耳屏瓣”结构,术中均采用“耳屏瓣”联合“Z”改型法再造耳屏,对于耳屏周围的凹陷畸形取周围多余的软骨及筋膜组织瓣进行填充;另6例(8耳)患儿因未找到自然的“耳屏瓣”结构,采用其他方法再造耳屏,也获得了相对满意的耳屏结构。结果:术中及术后未观察到明显并发症,术后随访1~12个月,未见明显瘢痕及软骨增生。再造的耳屏立体感较强,耳屏处凹陷得到良好矫正,与健侧接近,双侧耳屏畸形患儿基本实现双侧对称性耳屏,患儿及家长均满意。结论:先天性耳屏畸形患儿临床表现多样,采用“耳屏瓣”联合“Z”改型法可以矫正大多数先天性耳屏畸形,该方法手术时间短、瘢痕少、并发症少,并且可以获得自然的耳屏结构。

Objective:To explore the clinical effect of"tragus flap"combined with"Z"modification method in the surgical correction of congenital tragal deformity in children.Methods:The clinical data of 36 children with congenital tragal deformity who were operated in Children’s Hospital of Nanjing Medical University from June 2016 to June 2021 were retrospectively summarized,30 children(35 ears)with congenital tragal malformation had a natural"tragus flap"structure.During the operation,"tragus flap"combined with"Z"modification method was used to reconstruct the tragus.For the depressed deformity around the tragus,the cartilage and fascia tissue around the tragus were used for filling.In the other 6 cases(8 ears),because the natural"tragus flap"structure was not found,the tragus was reconstructed by other methods,and a relatively satisfactory tragus structure was obtained.The overall effect was satisfactory.Results:No obvious complications were observed during and after the operation.No obvious scar and cartilage hyperplasia were found during the follow-up of 1-12 months.The reconstructed tragus has a good three-dimensional shape,and the depression at the tragus has been well corrected,which is close to the healthy side.The children with bilateral tragus deformity basically achieve bilateral symmetrical tragus,which is satisfactory to the children and their parents.Conclusion:Although the clinical manifestations of congenital tragal malformation are various,"tragus flap"combined with"Z"modification method for tragus reconstruction can be used for most cases.The method not only has shorter operation time,less skin scar and fewer complications,but also can obtain more natural tragus structure.