无需植皮的皮肤软组织扩张法耳廓再造术

Auricular reconstruction by soft tissue expansion techniques without skin grafting

目的探讨一期采用大容量扩张器或双扩张器重叠扩张，二期无需植皮进行耳廓再造的方法，并评价其临床效果。方法2006年1月至2010年1月，对15例Ⅱ或Ⅲ度小耳畸形的患者，采用一期在耳后区上、下重叠各埋植1个扩张器（50和70m1）的重叠扩张，常规注水扩张；13例I度小耳畸形及3例Ⅱ或Ⅲ度小耳畸形患者，采用1个100ml扩张器，适当超量扩张。二期取出扩张器，以自体肋软骨或Medpor材料作为支架，筋膜瓣包裹支架，设计上部扩张皮瓣覆盖支架前侧及后侧上部，下部扩张皮瓣覆盖支架后侧下部，残余扩张皮瓣向下推行转移后覆盖耳后颅侧壁创面。结果所有患者术中均无需另取皮片移植，术后再造耳轮廓清晰，形状逼真，无感染及支架外露等并发症，1例耳后皮瓣远端出现约0．5cm×0．5cm表皮水泡，经换药后愈合。随访6—12个月，患者胸部供区切口瘢痕面积为（5．2±0．6）cm。，无明显并发症发生，31例患者中有28例对再造耳外观满意或比较满意，满意率为90％（28／31）。结论该方法可以扩张出足够的皮肤组织，在二期耳再造时，通过合理设计扩张皮瓣而覆盖耳后创面，无需植皮，并发症少，软骨供区瘢痕明显减小。

Objective To investigate a method of auricular reconstruction by soft tissue expansion techniques without skin grafting. Methods Two tissue expanders （50 ml and 70 ml） were implanted under the skin of mastoid in 15 patients with grade I] or llI microtia. One big expander（100ml） were implanted under the skin of mastoid in 13 patients with grade I microtia and 3 patients with grade Ⅱ or Ⅲmicrotia. After skin expansion, the expanders were taken out. The autologous rib cartilage or Medpor scaffolds were implanted. The superior expanded skin flap was used to cover tbe frontal surfaee and the upper part of the back surface of the framework. The inferior expanded skin flap was transplanted to cover the lower part of the back surface of the framework. The remained expanded skin flap was transplanted to cover the wound in the lateral of head. Results No skin graft was needed in all the patients. Epidermis blister occurred at the distal part of flap in one case. No other complication was happened. A follow-up of 6 to 12 months （mean 10.9 months）was carried out in all patients with good cosmetic result when the reconstructed ear underwent second-stage operation. The scar size on the dornor site was （5.2 ±0.6） cm2. The satisfactory rate was 90% （28/31）. Conclusions The expanded skin with this new method is enough for auricular reconstruction without skin grafting, leaving less complication and less scar at donor site.