改良Nagata法耳廓再造术治疗小耳畸形

Auricular reconstruction for microtia with modified Nagata method

目的在Nagata法的基础上探索改进一种耳廓再造的方法。方法对90例小耳畸形患者（101耳）进行了二期法耳廓再造。手术分两期进行，两次手术间隔6个月。I期采用Nagata法，应用自体肋软骨雕刻成三维支架行耳廓再造，包括自体肋软骨切取、耳支架雕刻成形、残耳的修整，将雕刻的三维耳支架埋置于乳突区皮瓣下、耳垂转位衔接于再造耳的下方等。Ⅱ期采用两瓣法耳颅角成形术，于再造耳的耳轮外缘外侧0．5cm处设计切口，掀起再造耳，并在耳支架深面携带较厚的耳后筋膜；将I期手术预留埋植的肋软骨作为耳后支撑支架，调节支架位置与角度，使再造耳的形态、位置、轴向等接近于健耳，并使颅耳角较对侧稍大；在再造耳廓的上方及下方乳突区各设计一个任意皮瓣，分别向颅耳沟旋转移转，将两皮瓣对位缝合，覆盖支撑软骨；皮瓣两侧创面分别植皮。结果所有患者均取得较好效果，90例患者（101耳）中96耳手术效果满意，5例患者基本满意。5只再造耳出现皮瓣尖端小面积坏死，经换药后痊愈，对手术结果无影响；2耳出现耳轮处软骨支架外露，通过转移局部皮瓣覆盖后痊愈，术后结果基本满意；4耳Ⅱ期术后出现耳颅角回缩。随访67例患者，时间3—24个月，再造耳三维立体轮廓清晰，颅耳角维持在20。～30，形态稳定，效果满意。结论该改良Nagata法耳廓再造术是一种较为实用、简单易行的方法。

Objective To investigate a method for total reconstruction of auricle. Methods 90 patients（ 101 ears） with congenital microtia underwent two-stage operations for auricular reconstruction. The first stage involved fabrication and grafting of autologous costal cartilage, removing the remnant ear cartilage, embedding the framework into local flap of the mastoid region, transferring the remnant ear lobule flap to link to the inferior framework. The second stage was creating an anriculocephalic sulcus. The reconstruction was performed 4 - 12 months after the first surgery. Skin incision was made 5 mm lateral side of the posterior margin of the auricle. The ear framework carrying a thick ear fascia was separated from the side of the head, the frames of the costal cartilage banked at the first operation were harvested, shaved and transplanted to the posterior wall of the concha with sutures; adjust stand position and angle, so that made the ear shape, position, axis, close to the healthy ear, and auriculocephalic angle was slightly larger than the contralateral ear. Two random flap was designed with superior on the root of the helix and in the inferior-posterior direction of the inferior mastoid area, two flapes were elevated and transplanted to posterior auricular sulcus to cover the grafted cartilage. Skin graft was performed in the remaining raw surface~ Results A total of 90 patients were operated, all of 101 constructed ears achieved satisfied or near satisfied shapes. Five cases of partial skin flap necrosis were caused by pedicle impairment. Exposure of cartilage framework happened in two cases. The anriculocephalic su｜cus of four cases diminished after the second stage operation. Three month to two-year follow-up of 67 patients showed that the reconstructed ears were satisfied with the results, including good shapes and steady auriculocephalic angles. Conclusions The method is a simple, safe and reliable method for total aural reconstruction.