皮肤扩张自体肋软骨Medpor耳基复合耳郭支架再造全耳12例

Expanded skin flap and compound auricular framework of autogenous costal cartilage and Medpor for total auricle reconstruction in 12 cases

目的:观察应用耳后扩张皮瓣联合自体肋软骨与Medpor耳基复合耳郭支架行全耳再造术的效果,以及不良反应和副作用。方法:选择2002-05/2005-10锦州医学院附属第一医院烧伤整形科收治的小耳或耳郭缺损畸形,采用扩张皮瓣、自体肋软骨Medpor耳基复合耳郭支架两期完成全耳再造患者12例。10例为第一、二腮弓综合征的先天性单侧小耳畸形,均有残耳垂,其中7例有外耳道,3例外耳道闭锁;2例为后天外伤性耳大部分缺损,但残留部分耳垂。先在耳缺损区埋置扩张器,定期注入扩张,皮量够用后,取出扩张器,切取第8或第9肋软骨做耳轮,Medpor材料做耳基,联合制成复合耳郭支架,置于耳缺损区扩张皮瓣后面,复合耳支架外缘用颞浅筋膜瓣及耳后筋膜瓣包绕,耳后区域植皮。结果:12例患者随访6个月,均进入结果分析。①自体肋软骨Medpor耳基复合耳郭支架行全耳再造效果:患者术后无排斥反应,无明显吸收变形,外形逼真,患者满意。厚度及色泽与残耳或邻近皮肤接近,耳外形立体感强,用手触摸可有部分感觉功能。②不良事件及副反应:1例因包扎过紧在耳轮处皮肤坏死大小约0.5cm×0.8cm,1例在耳轮上角肋软骨与Medpor耳基连接点金属丝外露,2例经局部修复后3周内痊愈。结论:皮肤扩张覆盖自体肋软骨Medpor耳基复合耳郭支架全耳再造术,形态逼真,立体感强,借鉴了单纯肋软骨支架和单纯Medpor支架的优点,同时又克服了它们各自的缺点。

AIM： To observe the effect of expanded skin flap and compound auricular framework of autogolous costal catilage and Medpor in total auricle reconstruction, and adverse events and side effects. METHODS： From May 2002 to October 2005, we chosen 12 patients with microtia or auricular monstrum deficiens and received treatment by using expanded skin flap and compound auricular framework of autogolous costal cartilage and Medpor for total auricle reconstruction in two stages in the Department of Burns and Plastic Surgery, First Hospital Affiliated to Jinzhou Medical College. Ten of 12 cases had congenital unilateral microtia of the first and second branchial arch syndrome, all had defected ear lobe. Among the 10 cases, 7 had acoustic duet, 3 had aural atresia; 2 had traumatic defects, but part of ear lobe was left. Firstly, soft tissue expander was implanted under the subcutaneous layer in the defected area. Water was injected for expanding periodically. Expander was taken out when the skin was enough. Secondly, the 8^th or 9^th autogenous costal cartilage was harvested as helix. The compound framework （Medpor compounded with the 8^th or 9^th autogenous costal cartilage） was fastened on the auricular fascia, Then temporal or retroauricular fascia flap was transferred to coat the framework. The expended skin flap in the retroauricular-mastoid area was transferred onto the fascia flap-packed framework at last. RESULTS： Twelve patients were followed up for 6 months, and all of them entered the stage of result analysis.①Total auricle reconstruction by using compound auricular framework autogenous costal cartilage and Medpor has got satisfactory effect： There was no rejection reaction and no obvious absorption and deformation after operation, The reconstructed ears showed a good appearance, texture and satisfactory contour with sharp outlines. The reconstructed ear possessed close color and thickness to the residual ear or adjacent skin. There was a better stereoscopical feeling from the appearance. Partial feeling function existed when touching it by hand. ②One of twelve had a little skin necrosis （ about 0,5 cm×0.8 cm）at the helix due to tight package and one patient was found mental wire exposing at the jointing point of above costal cartilage and Medpor , Within 3 weeks, they healed after local reparation. CONCLUSION： Compound auricular framework of autogerous costal cartilage and Medpor covered by expanded skin flap is a suitable method for total auricular reconstrucation due to vivid morphology and good third dimension, being with the advantage of simple costal cartilage framework or Medpor, overcoming their respective shortages.