Ⅱ度小耳畸形残耳组织在再造耳修整中的作用

Effect of the remnant tissue of deformed ear on reconstruction of Ⅱ microtia

目的探讨如何合理有效地利用Ⅱ度小耳畸形的残耳组织，对再造耳进行局部修整，同时加深扩大耳甲腔的方法。方法对48例Ⅱ度小耳畸形患者再造耳进行修整。所有患者Ⅱ期均采用大容量扩张器扩张无需植皮的全耳再造术。在Ⅲ期再造耳修整时残耳组织量充足。在残耳垂上部做倒V形切口，并与再造耳耳轮下端的辅助切口形成Z字，皮瓣交叉行耳垂转位；在耳屏相应部位做M形皮瓣，缝合后再造耳屏，通过该切口剥离残耳软骨及多余软组织到骨膜表面扩大加深颅耳沟，形成两个蒂分别在耳轮缘及屏间切迹处的残耳皮瓣，交叉缝合以覆盖耳甲腔创面。结果残耳复合组织再造的耳屏成活良好，无一例出现组织坏死的情况，再造的耳屏形状逼真。覆盖于耳甲腔的残耳皮瓣成活良好，随访3～6个月再造耳屏无明显变形，转移皮瓣无明显挛缩。结论残耳组织在Ⅱ度小耳畸形患者再造耳修整中是良好的材料，通过合理设计，可完全覆盖耳甲腔创面，不仅可明显改善再造耳的外观，而且无需另取组织游离移植，耳甲腔无明显挛缩变小的情况。

Objective To investigate the effective application of the residual tissue of deformed ear in local repairing the reconstructed ear of Degree Ⅱ microtia and deepening and widening the cavity of auricular concha at the same time. Methods Under high-capacity expandor, 48 patients with Degree Ⅱ microtia were repaired by secondary whole ear reconstruction without skin grafting, while the enough tissue of the deformed ear could be harvested at three-stage. The V-shaped incision made in the upper remnant earlobe combined with the lower incision on the edge of the helix to form a Z-shaped incision; ear lobe was dislocated by the ear lobe flaps overcross. M-shaped flaps were made in the place of tragus, and then the flaps were sutured to performing the ear reconstruction. Through the incision, the remnant cartilage and soft tissue in the place of auricular concha were then dissected to the periosteum for deepening and widening the cavity. Two residual ear flaps were made with the pedicle on the edge of antihelix and incisura intertragica. These two flaps were then transplanted to cover the wounds in the cavity of auricular concha. Results All the reconstructed tragus and transplanted skin flaps in the cavity of auricular concha survived well without necrosis in any cases. And the appearance of all reconstructed tragus was nature. There was no cavity of auricular concha deformation after 3 to 6 months following up, and all were satisfied without deformities of the reconstructed tragus and contracture of the transplanted flaps. Conclusion The tissues of residual ears are good stuff in the prostheses of reconstructed ears. If only these tissues are used fully and reasonably, the cavity of auricular concha will be covered all by flaps without skin grafting. There were on contraction on the cavity of auricular concha and the appearance of reconstructed ears can be improved.