应用MEDPOR支架施行儿童全耳再造术中若干问题的探讨

Exploration of some questions on the total auricle reconstruction witha Medpor framework in children

目的:探讨以Medpor支架施行儿童全耳再造术中存在的若干问题,以利于改进该手术的整复效果。方法:回顾性分析应用该支架施行全耳再造术患儿的临床资料。2000～2004年,应用该支架施行全耳再造术20例,其中左侧6例,右侧14例。一期再造11例(Medpor支架植入、颞浅筋膜瓣与残耳皮瓣转移加全厚皮片移植);二期再造9例(其中耳后皮瓣扩张法2例;一期残耳旷置、Medpor支架植入、颞浅筋膜瓣转移加全厚皮片移植,二期耳垂、耳屏成形7例)。结果:该术式须注意如下问题:①颞浅筋膜瓣分离厚度与面积的标准;②支架的修整与颞浅筋膜瓣、皮瓣的适应及其固定;③扩张皮瓣、皮瓣或植皮的选择及其操作;④皮瓣坏死与支架外露。结论:该术式在儿童病例的操作中尤须做到:①保证颞浅筋膜瓣良好的血供与足够的面积;②应参照术前的设计,将支架重新塑形并修整光滑,使其稳妥固定;③颞浅筋膜瓣、皮瓣与皮片必须平整、紧贴并完全覆盖支架,各层缝合缘宜错开。适宜者可用扩张皮瓣。④皮瓣坏死与支架外露,经过换药或再次手术可以修复。属于组织排斥现象,则须取出支架。

Objective: To explored some questions on the total auricle reconstruction with a Medporframework in children , for improving the clinical effects. Metheds: The clinical date of 20 cases ofchildren were reviewed and analysed. Results: The questions on the auricle reconstruction with aMedpor framework in children were: ① the standard of thickness and areas of superficial temporalfascia flap; ② the trim and fixation of the framework; ③ choice and operation of the flaps; ④ thenecrosis of the flap and exposure of the framework. Conclusion: Medpor framework had a excellenthistocompatible. But operaters must payed a special attention to those questions and adopted amore circumspect operation in children.