皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形

Auricle reconstruction with expanded auricle posterior flap on mastoidea and auto rib cartilage bracket for repair of congenital microtia

目的探讨耳后乳突区皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形的临床效果。方法21例先天性小耳畸形患者，分3期进行手术治疗。Ⅰ期：患侧耳后乳突区皮下埋置50ml肾形扩张器，术后定期注水，扩张皮肤3～4个月，平均注水（80．51±3．87）ml，达预定量后稳定养护1个月。Ⅱ期：取自体肋软骨，雕刻成由4层软骨构成的耳支架，整体为倒立的海螺样外观，将扩张皮瓣覆盖于整个自体肋软骨支架表面，再造耳廓。Ⅲ期：Ⅱ期术后3个月对成形耳进行细节性修整。结果21例患者手术均获成功，成形耳廓大小、外形均与健侧相似，医患双方满意。结论耳后乳突区皮肤扩张法所扩张的皮肤，可覆盖于整个自体肋软骨支架表面，术后耳廓外形逼真，立体感强。

Objective To explore the clinical effect of auricle reconstruction with expanded auri- cle posterior flap on mastoidea and auto rib cartilage bracket for repair of congenital microtia. Methods Twenty-one eligible patients with congenital auricle malformation and defect were recruited into this study and three-stage operation was performed. A 50 ml kidney-shaped expander was implanted at mastoid process area to expand skin in stage Ⅰ surgery, followed by a regular affusion to expand skin for 3 to 4 months. The average total waterflood was （80.51 ± 3, 87） ml. The volume remained stable for 1 month, once up to the predetermined amount. In stage Ⅱ surgery autogenous costal cartilage was taken and carved into inverted conch shape. Auricle was reconstructed with the expanded flap to cover the auto rib cartilage bracket. The stage Ⅲ surgery was performed for details dressing of the au- ricle after 3 months. Results All 21 cases underwent operation successfully. Reconstructed ear auri- cles were similar to uninjured sides in size and shape. Both doctors and patients were contented with the auricles. Conclusions Expanded auricle posterior flap on mastoidea can cover the auto rib cartilage bracket. Autologous costal cartilage can be carved to four layers cartilage bracket that likes an inverted conch, and followed by realistic postoperative auricular shape and strong three-dimensional sense after operation.