颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架外耳再造术

Application of both expanded cutaneous flap and temporoparietal fascia flap in ear reconstruction with Medpor framework

目的 探讨颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架再造外耳的效果。方法 手术分两期进行：一期手术在乳突区置入皮肤软组织扩张器，并定时注水扩张；第二期手术将扩张器取出并形成蒂在前的扩张皮瓣、掀起以颞浅血管为蒂的颞顶筋膜瓣，应用颞顶筋膜瓣和乳突区扩张皮瓣双重由里至外覆盖Medpor耳支架完成耳廓再造。结果 临床应用22例，随访半年至2年半，无耳支架外露发生，再造的耳廓外形逼真，轮廓分明，肤色与周围正常皮肤一致。结论 应用乳突区扩张皮瓣及颞顶筋膜瓣双层组织瓣包被Medpor耳支架，可以提高Medpor耳支架置入的安全性，避免发生外露，又不影响支架外形和轮廓的显现，再造耳表面皮肤的色泽与周围皮肤一致。

Objective To investigate the feasibility and results of application of both expanded cutaneous flap and temporoparietal fascia flap in total ear reconstruction with Medpor framework. Methods The main procedure consists of two stages： Stage I-skin expansion; Stage H-auricle formation consists of orientation of Medpor implant and creation of coverage for the implant by both expaned skin flap and temporoparietal fascia flap. Results Twenty-two ears in 22 unilateral microtia patients were constructed using Medpor implants covered with both expanded cutaneous flap and temporoparietal fascia flap over the last three years, they were accepted as pleasing by the patients. Conclusions Application of both expanded cutaneous flap and temporoparietal fascia flap can assure no extrusion of Medpor implant in ear reconstruction. Either more, the two layers of transferred tissues will not affect the profile details of the reconstructed ear. And because the skin covering the framework and fascia is derived from mastoid region, the appearance and profile of the reconstructed auricle is true to nature and close to that of the opposite one.