耳后联合筋膜皮瓣全耳廓再造的临床研究

Joint expansion of fascia flap for full-ear reconstruction

目的:探讨颞顶筋膜瓣、耳后筋膜瓣两瓣(简称:耳后联合筋膜瓣)包裹Medpor支架行先天性小耳畸形全耳再造术的方法和效果。方法:手术分为两期:Ⅰ期采用颞浅动静脉顶支为血管蒂的岛状筋膜瓣,植入残耳乳突区耳后剥离的皮下腔穴,然后植入皮肤扩张器与耳后筋膜皮瓣进行同期同步扩张;Ⅱ期取出扩张器,将扩张耳后联合筋膜皮瓣包裹Medpor支架行全耳廓再造术。结果:38例患者中,经6个月～3年的随访,再造耳形态结构稳定,颜色与周围皮肤相近,微细结构清晰,颅耳角良好与健耳对称。结论:该方法既可解决覆盖支架的难题,又将手术并发症减少到最低限度,避免支架外露。是目前较为理想的全耳廓再造术的一种新方法。

Objective Study on temporoparietal fascia flap and fascial flap in ear （Joint expansion of fascia flap） cover the Medpor to do congenital microtia full ear reconstruction. Methods Surgery has two stages. I stage： Adapt the top branch of the superficial temporal artery and vein as pedicled island fascial flap, transplant into the subcutaneous cavity of residual ear, and then insert tissue expander. II stage： take out expander, joint fascial flap covers Medpor to do full-ear reconstruction. Results Within 6 months to 3 years visiting 38 cases, reconstructed ears have lifelike appearance. They have similar color with the surrounding skin. Auriculocephalic angle is good and symmetric with healthy ears. Conclusions This method can reduce complications of surgery and avoid the exposed support. It is the ideal choice usina ioint fascial flap for full-ear reconstruction.