皮肤扩张法耳廓再造术修复烧伤后不同程度耳廓缺损

Repaning of Different Extents of Ear Defect After Burn Using Auricular Reconstruction with Skin Expansion

目的探讨皮肤扩张法耳廓再造术在烧伤后耳廓不同程度缺损修复中的应用效果和操作要点。方法手术分两期进行：一期行耳后乳突区皮肤扩张器植入术；二期取出扩张器，形成蒂在前方的耳后皮瓣及耳后皮下组织筋膜瓣，采取自体肋软骨雕刻成耳支架，将耳支架植入耳后皮瓣与筋膜瓣之间，乳突区创面植以中厚皮片，共修复33例烧伤后耳缺损患者。结果33例患者术后皮瓣血运良好，无坏死，植皮均成活，6～12个月以后外形良好，形态逼真，立体感强，耳轮、对耳轮、三角窝均清晰可见，耳廓无明显异位或变形吸收，无明显挛缩。再造耳廓外形满意。结论皮肤扩张法耳廓再造术应用于烧伤性耳廓不同程度缺损畸形的耳廓再造，是一项切实可行的手术方法。

Objective To investigate the result and operating points of auricular reconstruction with skin expansion in the repairing of different degrees of auricular defects after burn. Methods The operation consists of two stages. Stage I： A skin expander is implanted into subdermal space in the post auricular mastoid region; Stage II ： Remove the skin expander, and lift a retro-auricular skin flap pedicled on the anterior side. After sculptured and assembled, autogenous costal cartilage framework is placed between the Retro-auricular skin flap and fascia flap. The wound in the mastoid region is covered with medium thickness skin graft. 33 patients with auricular defects after burn were repaired. Results All the flaps of thirty-three patients had good blood supply and no necrosis occurred in the flap and skin graft after operation. After a follow up of 6 -12 months, the reconstructed auricles had good appearance, lifelike shape and strong sense of three-dimension. The helix, antihelix and triangular fossa were clear. The costal cartilage framework did not show any indication of absorption, deformation and contrac- tion. Above all, the reconstructed auricle showed satisfactory, appearance. Conclusion Auricular reconstruction with skin ex- pansion is a practicable method to auricular reconstruction of the different degrees of auricular defect after burn.