外耳再造与轻度半侧颜面短小症同期修复术

Auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in onestage

目的探讨外耳再造术的同时行真皮脂肪组织填充纠正轻度颜面短小症的新方法，评价其优缺点。方法对28例小耳畸形合并轻度半侧颜面短小症的患者，采用一期耳后乳突区埋植扩张器，二期行自体肋软骨支架移植耳再造术，在耳再造的同时，利用供皮区剩余的真皮脂肪组织进行患侧面部填充纠正颜面部软组织发育不良，并与20例采用传统扩张法耳再造术的患者进行比较。结果所有采用同期手术的患者在完成耳再造的同时，面部外观也得到明显改善，感染及支架外露各l例，发生率为7％（2／28），与传统组（5％，1／20）比较，差异无统计学意义（P〉0．05）。同期手术组患者对术后整体效果的满意率为93％（26／28），明显较传统组高（80％，16／20，P〈0．05），患者及家属对手术效果均较满意。结论在外耳再造的同时，利用废弃的真皮脂肪组织进行面部轻度畸形的矫正，效果良好。

Objective To evaluate the effect of auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in one stage. Methods 28 cases with microtia and grade I and Ⅱ hemifacial microsomia were treated. The tissue expander was implanted under the skin of mastoid at the first stage. At the second stage, the auricular reconstruction was performed with autologous rib cartilage framework. The remained dermal fat tissue from the donor site was inserted subcutaneously to correct the asymmetric face of microsomia. 20 cases, who underwent auricular reconstruction only, were used as control group. Results The facial asymmetry was greatly improved after operation in the 28 cases. The complications happened in 7% （2/28） of the patients, including one case of infection and one case of framework exposure. While it was 5% （1/20） in control group, showing no significant difference between the two groups （P 〉 0.05）. The satisfactory rate was 93% （26/28） in one-staged group and 80% （16/20） in control group （ P 〈 O. 05 ）. Conclusions The dermal fat graft which should be abandoned in the traditional auricular reconstructions could be used to correct mild hemifacial microsomia with satisfactory appearance improvement.