耳郭再造的应用解剖学研究

Applied anatomy study of auricle reconstruction

目的:研究耳郭及乳突区的解剖层次,观察耳后动脉及颞浅动脉的分支数量及走行特点,为耳郭再造术的开展提供可靠的解剖学基础,并改良传统的耳郭再造手术方案应用于临床。方法:利用显微解剖学技术和一般解剖学方法,对10具(20侧)经颈外动脉乳胶灌注的尸体标本的耳郭及乳突区进行逐层解剖,观察耳后动脉及颞浅动脉的分支数量及走行特点。临床上根据Tanzer原理,对8例小耳畸形患者行分期耳郭再造改良术。结果:①耳郭的组织层次由浅至深依次为皮肤、皮下组织、软骨膜、耳郭软骨;②耳后动脉和颞浅动脉各自发出的2～3支分支及其相互吻合形成的血管网是耳郭及乳突区的主要供血动脉;③耳后动脉和颞浅动脉之间有两种血管吻合,一是位于耳郭后面上部的耳郭血管吻合网,另一种是位于头皮内的头皮血管吻合网。结论:①耳后动脉和颞浅动脉是耳郭及乳突区的主要血供来源,各自恒定地发出2～3支分支供应耳郭,且二者间有丰富的血管吻合;②注意不要损伤真皮下血管网是保证皮瓣成活的关键;③残耳可分为三部分进行充分利用。

Objective To study the anatomy levels of the auricle and mastoid, the branches and the way of the posterior auricular artery and the superficial temporal artery, practice the research achieve mends in clinic, in order to guide the operation of auricle reconstruction usefully. Methods Twenty sides of ten cadaverics are perfused by emulsion through external carotid artery. To observe the branches and the way of the posterior auricular artery and the superficial temporal artery. Results （1）The tissue levels of auricle from superficial to deep in turn are skin, subcutaneous tissue, cartilage periosteum, and auricular cartilage. （2） The main arteries of the auricle and mastoid are the posterior auricular and the superficial temporal artery, from which 2-3 branches arise respectively, anastomosis net between them. （3）There are two kinds of artery anastomosis between the posterior auricular artery and the superficial temporal artery, one auricle artery anastomosis net is behind the above of auricle ,and the other another is in the artery anastomosis net of head skin. Conclusion （1）The posterior auricular artery and the superficial temporal artery are main blood supplies of the auricle and mastoid, and they distribute 2-3 branches controlling auricle in fixed way respectively, between which abundant artery anastomosis. （2）Take care not to damage the subdermal vascular net, it is the key to ensure the live of skin flap. （3）Stump ear can be made good used by dividing into three parts.