扩张皮肤覆盖肋软骨立体耳郭支架耳郭再造术

Reconstruction of auricle with three-dimensional framework of costal cartilages covered with expanded flap

目的完善和探讨以扩张皮肤覆盖肋软骨立体耳郭支架行耳郭再造的方法和疗效。方法自1991年10月至2010年5月，对300例耳缺损患者行全耳再造术。于耳前至乳突发际缘间行皮肤软组织扩张术，根据健侧耳的大小和形态，以及患者自身情况制作耳郭热塑模型；将热塑模型置入扩张皮肤的剥离腔隙，使扩张的皮肤完全覆盖模型，定位再造耳郭。取出模型作为参照制作肋软骨立体耳郭支架；将耳郭支架植入覆盖模型的扩张皮肤后，行贯穿纱布丁缝合固定；最后于再造耳郭的表面行石膏外固定，以对抗术后早期耳郭皮肤的收缩。结果术后随访234例患者1～24个月，其中耳甲腔皮肤过薄造成皮肤破裂者5例，经换药处理后痊愈；支架倒塌后造成耳郭与颅面帖合者8例，扩张皮肤不充足造成耳郭位置或角度不当者23例，经二次修复术后获得改善；其余患者均获得良好的再造效果。结论采用扩张皮肤、自体肋软骨立体耳郭支架，辅以耳郭热塑模型及石膏外固定，能取得良好的耳郭再造效果。

Objective To explore an effective method of auricle reconstruction with three-dimensional framework of costal cartilages covered with expanded flap. Methods From October 1991 to May 2010, 300 cases with microtia or auricular defect received the pan-auricle reconstruction. Skin soft tissue expansion was performed from preauricula to the space of mastoid and hairline edge, auricular thermoplast model was made according as size and shape of the normal ear; and then it was inserted into dissected lacuna of expanded skin to make the expanded skin cover the model and the auricular model was performed position fixing. The model was removed and used as a sample of three-dimensional framework of costal cartilages ; the framework of costal carti- lages was implanted into lacuna mentioned-above and was fixed with perforative suture with patches of gauze; the surface of the framework was performed the plaster external fixation to prevent the auricular skin from con- strietion at the early stage of postoperation. Results Of all 300 cases, 234 cases were followed up for 1 to 24 months, all were satisfied wit the results except for 5 cases with skin breakage because of the over-thin skin of cavity of coneha which were healed by change dressings, 8 cases with auricular collapse owing to the framework collapse, and 23 cases with inappropriate position or angles due to the shortage of skin expansion which were improved by secondary repair. Conclusion Auricle reconstruction by skin expansion, auricular three-dimension framework combing with auricular thermoplast model and plaster external fixation of autoallergic eostal cartilages can obtain the excellent results.