颅耳角成形术中颞浅筋膜与耳后筋膜应用的对比研究

A COMPARATIVE STUDY OF TEMPOROPARIETAL FASCIAL FLAP AND POSTAURICULAR FASCIAL FLAP IN THE EAR ELEVATION

目的比较耳再造二期手术中使用颞浅筋膜与耳后筋膜包被耳后支撑支架的效果。方法2005年6月-2007年5月,对72例先天性小耳畸形在全耳再造术一期埋植自体肋软骨术后6～10个月行二期颅耳角成形术。男47例,女25例;年龄5～28岁,平均12岁。左耳31例,右耳41例。根据Nagata残耳分型法56例为耳垂型,无外耳道;16例为耳甲腔型,均有外耳道存在,其中9例外耳道狭窄。术中29例使用同侧颞浅筋膜包被耳后支撑支架(A组),43例使用同侧耳后筋膜包被耳后支撑支架(B组)。结果患者均获随访,随访时间3～22个月。A组22例及B组33例植皮及筋膜完全成活;A组6例及B组9例局部表皮色泽略深,术后1个月表皮脱落愈合;A、B组各1例发生耳侧小面积(<1cm2)植皮及筋膜坏死,使用局部头皮瓣移位无张力覆盖缝合痊愈。术后患者颅耳角角度与健侧接近。两组耳后植皮处可见不同程度的瘢痕,A组19例及B组28例瘢痕较平整;A组7例及B组11例耳后出现局部增生性瘢痕;A组3例及B组4例瘢痕较严重,颅耳角有牵拉。A组患侧颞区均有新增瘢痕,12例脱发较严重;B组无新增瘢痕及脱发区域。随访6个月时,A组3例及B组5例颅耳角发生回缩(>0.5cm)。结论在耳再造二期手术中,包被耳后支撑支架的组织可选用患侧颞浅筋膜或者耳后筋膜,耳后筋膜的修复效果优于颞浅筋膜。

Objective To discuss the effects of the temporoparietal fascial flap and the postauricular fascial flap as the materials to cover the postauricular-frame during the second stage operation of the total auricular reconstruction. Methods From June 2005 to May 2007, the second stage elevation of the reconstructed auricle was performed at 6-10 months after the first stage total auricular reconstruction for 72 cases （left 31, right 41）, 47 males and 25 females, aged 5-28 years old （12 on average）. According to the Nagata＇s classification, 56 cases were lobule-type microtia with no external auditory canal, and the other 16 cases were concha-type microtia with external auditory canal （narrow in 9 cases）. Homolateral temporoparietal fascial flap was used to cover the postauricular-frame in 29 patients （group A）, and the homolateral postauricular fascial flap was used in the other 43 patients （group B）. Results All the patients were followed up for 3-22 months. A total of 55 cases had excellent skin flap and fascial flap （22 in group A and 33 in group B）. Darker epidermis could be seen in 15 cases （6 in group A and 9 in group B）, and it healed within one month after the operation. Two cases （1 in group A and 1 in group B） suffering from partial grafted skin and fascial flap necrosis （〈 1 cm^2） healed by means of coverage of local flap transfer. All the patients＇ reconstructed auriculocephalic angles were close to the normal side. There existed scars of varying degrees at the area of skin graft in both groups： 47 cases had fiat scars （19 in group A and 28 in group B）; 18 cases had hyperplastic scars （7 in group A and 11 in group B）; and 7 cases had severe scars with the auriculocephalic angles draw-off （3 in group A and 4 in group B）. Furthermore, there were obvious scars in temporal region and severe hair thinning at the donor site in group A, but there were no such conditions in group B. At 6 months of follow-up, reduction of the auriculocephalic angle occurred in 3 cases of group A and obvious in 5 cases of group B （〉 0.5 cm）. Conclusion Both the temporoparietal fascial flap and the postauricular fascial flap can be applied to cover the postauricular framework in the second stage reconstructed ear elevation,with superiority of the latter over the former.