颞浅筋膜瓣联合中厚植皮法修复外耳再造术后软骨支架外露

Repair of cartilage framework exposure after auricular reconstruction using temporoparietal fascial flap combined with split-thickness free skin grafting

目的探讨外耳再造术后出现皮瓣坏死、软骨支架外露后，应用颞浅血管为蒂的颞浅筋膜瓣联合中厚皮片植皮的方法进行修复的效果。方法沿颞部发际内行垂直切口，以颞浅血管为蒂，沿颞肌筋膜表面剥离，形成颞浅筋膜瓣，向下旋转包裹支架外露部位，筋膜瓣表面行游离中厚皮片移植，术后给予抗感染治疗3d。结果10例患者术后伤口均愈合良好，无支架外露、皮片坏死现象。随访3～12个月，其再造耳耳轮、对耳轮、三角窝等表面结构清晰，有明显的立体形态，不显臃肿，效果满意。结论对外耳再造术后出现软骨支架外露，利用颞浅筋膜瓣联合游离移植中厚皮片法可获得较满意的修复效果。

Objective To explore the effect of temporoparietal fascial flap pedicled superficial temporal vessel combined with split-thickness free skin grafting on the repair of flap necrosis and cartilage framework exposure after auricular reconstruction. Methods A vertical incision was made along the temporal hairline, a temporoparietal fascial flap was harvested above the surface of deep temporoparietal fascia with a pedicle of superficial temporal vessel, and the fascial flap was rotated downward to cover the exposed cartilage framework, then the surface of the fascial flap was covered with split-thickness free skin by grafting and routine anti-infection treatment was carried out for 3 days. Results Ten patients all healed satisfactorily without cartilage framework exposure or skin graft necrosis. All patients were followed-up for 3 to 12 months, and the surface structures of the reconstructed ear, such as the helix, antihelix and triangular fossa were clear with obvious three-dimensional shape and without obvious bulk. Conclusion For the repair of the cartilage framework exposure after external ear reconstruction, the method of superficial temporal fascia flap combined with split-thickness free skin grafting could obtain the satisfactory results.