乳突区双扩张器重叠埋置在全耳廓再造术中的应用

Application of overlapped implantation of double tissue expanders in mastoid region for ear reconstruction

目的介绍应用两个皮肤软组织扩张器叠加埋置的方法进行全耳廓再造的临床经验。方法自2008年1月至2011年12月,共27例小耳畸形患者实施该方法。一期手术在患侧乳突区埋置肾形皮肤软组织扩张器80mL(或100mL)和50mL各一个,将体积大的扩张器叠加放置在体积小的扩张器之上,术后定期交替扩张器注水3～6月。二期手术全部采用Medpor人工耳廓支架,取出扩张器,将扩张的皮瓣直接包裹支架,负压维持耳廓成形。结果随访时间4～50月,27例再造的耳廓外形位置良好,皮肤质地与周围皮肤相近,颅耳沟稳定无回缩,扩张皮瓣无坏死。2例患者因伤口裂开发生耳廓支架外露(7.4%),进行一次修补手术后恢复良好。结论乳突区叠加埋置两个扩张器全耳廓再造术,避免了植皮,不再使用耳后筋膜瓣和颞筋膜瓣,手术过程简单化,缩短了手术时间,部分再造耳廓亚单位欠清晰,但总体效果满意。

Objective To present our clinical experience in using two tissue expanders implanted superposingly in the mastoid region and Medpor ear framework for congenital microtia reconstruction. Methods During the period from Jan 2008 to Dec 2011, 27 patients were treated by total ear reconstruction. In the first surgical stage, the 50 mL and 80 mL （or 100 mL） of kidney- shaped tissue expanders were implanted subcutaneously in mastoid region and then overlaid the big expander on the small one. After the first surgery stage they were inflated with normal saline alternately for 3 to 6 months until the tissue expander was removed in the second surgical stage. After that the anterior and posterior wall of the Medpor ear framework was directly covered by expanded skin flap. A drainage tube was introduced into the space between the expanded skin flap and the ear framework to maintain a healthy contact between them and the contour of the reconstructed auricle. Results The postoperative follow-up time ranged from 4 to 50 months. 27 patients acquired symmetrical, subtle contour, prominent reconstructed auricles. The new reconstructed ear had a good contour and nearly normal skin. The postauricular suleus was stable and the expanded skin flap looked well without necrosis. The Medpor ear framework was exposed in 2 patients （7.4%） because of wound dehiscence and he healed uneventfully after a further repair surgery. Conclusion For this operation, overlying implantation of double tissue expanders solved the problem of insufficient amount of the skin flap, avoided postauriclar skin grafting and application of the temporoparietal fascia and postauriclar fascia, simplified the surgical procedure and shortened the operation time significantly. The subunit of some reconstructed ear was unclear, but this method gets reliable and satisfactory results.