自体肋软骨与Medpor耳基复合耳廓支架一期全耳廓再造11例

Application of autogenous costal cartilage and Medpor surgical implant in one-stage total auricle reconstruction in 11 cases

目的：耳支架的选择对于成功塑造一个外形逼真,与健耳对称匹配,不易吸收的再造耳具有相当关键的作用。观察自体肋软骨与Medpor耳基复合耳廓支架行全耳廓再造术的临床效果。方法：①试验对象：选择2006-01/2007-01在上海交通大学医学院附属第九人民医院耳鼻咽喉科就诊的先天性小耳畸形11例,术前签定手术知情同意书及医疗植入物知情同意书。②主要材料：Medpor耳基支架由美国PARK大学Porex外科医疗公司生产。③试验方法：取自体第九肋软骨作为耳轮,Medpor耳基复合支架植入,覆盖颞筋膜瓣和游离皮片一期完成全耳廓再造术。④试验评估：于术后2周,3个月,6个月,12个月随访,观察再造耳廓的成活情况及形态。结果：11例患者再造耳均成活,术后随访6~18个月,无一例支架外露。未出现排异,过敏及其他不良反应。10例再造耳廓形态逼真,质感柔韧,立体感强,颅耳角与健耳对称。有1例因为瘢痕体质导致术后瘢痕增生,耳廓形态不佳。结论：采用自体肋软骨＋Medpor耳基复合耳廓支架行全耳廓再造术,既弥补了单纯用Medpor支架植入质地偏硬,易外露的缺点,又解决了肋软骨耳支架远期易吸收变形和手术创伤大的缺点,是目前较为理想的全耳廓再造支架。

AIM： The selection of an car stent is important for a successful reconstruction ear of a truly appearance, no exposure, no distortion and symmetrical with the intact ear. This article investigated the clinical effect of auricle reconstruction with autogenous costal cartilage and Medpor surgical implant. METHODS： （1）Eleven cases with congenital microtia who received trcatment in the Department of Otolaryngology of Shanghai Ninth People＇s Hospital of School of Medical of Shanghai Jiao Tong University from January 2006 to January 2007 were enrolled. They signed the informed consent of the surgery and the implant. （2）Medpor ear base stent was produced by Porex Surgery Medical Company of America PARK University. （3）A compound auricular framework was composed of the ninth autogenous costal cartilage as car rim and Medpor ear base, then the temporal superficial fascia and skin enclose it in one-stage total auricle reconstruction. （4）The survival and outline of the reconstructed auricles were observed in the 2-week, 3-month, 6-month and 12-month follow up after the surgery. RESULTS： The auricle reconstructions of eleven cases were all successful. No framework exposure was found in 6-month to 18-month follow-up. No material rejection, allergy or other side effects were found. The reconstructed auricles look natural, true and the outline was symmetrical with the intact ear in 10 cases. One case looks dissatisfactory because of scar proliferation due to scar predisposition. CONCLUSION： The auricle reconstruction with autogenous costal cartilage and Medpor surgical implant has advantages of a truly appearance, no exposure, no distortion and little complications. It may be an ideal framework for auricle reconstruction at present.