“单瓣扩张法”耳郭再造术的临床应用

Clinical application of ＂single expanded flap＂ technique in auricular reconstruction

目的 探讨“单瓣扩张”技术在耳郭再造中的临床应用.方法 手术分3期完成：Ⅰ期耳后扩张器置入术;Ⅱ期扩张器取出,肋软骨切取,耳郭支架雕刻,扩张皮瓣包裹耳郭支架;Ⅲ期再造耳修整,耳屏再造,耳垂转位,耳甲腔加深.自2012年6月至2014年1月,对74例小耳畸形患者行“单瓣扩张法”耳郭再造术.结果 所有患者随访1 ～ 18个月,5例扩张器渗漏,2例血肿,3例扩张皮肤破溃,1例伤口裂开,1例软骨外露;其余患者获满意效果,再造耳形态结构稳定,位置、大小、方向、耳颅角高度与健侧耳基本对称,耳轮、耳舟、对耳轮及其上下脚、三角窝、耳屏、耳甲腔等结构清晰自然,再造耳前后色泽、质地一致,耳后瘢痕不明显.结论 “单瓣扩张法”耳郭再造术是利用耳后扩张皮瓣包裹耳支架,无需筋膜瓣和皮片移植,即可形成结构清晰自然、稳定竖立的再造耳;手术过程简单,创伤较小,瘢痕较少.为耳后皮肤厚或者耳后皮肤松、薄的小耳畸形患者提供了一种较理想的治疗方法.

Objective To explore the clinical application of ＂single expanded flap＂ technique in auricular reconstruction.Methods Auricular reconstruction was performed in three surgical stages.At the first stage,a 50 ml or 80 ml expander was inserted in the retroauricular mastoid region; at the second stage,after the expander was removed,the autogenous costal cartilage was havested and framework was sculptured.The cartilage framework was then wrapped by the expanded skin flap.Tragus construction,lobule transposition and conchal excavation were performed at the third stage.From June 2012 to Januay 2014,78 ears from 74 congenital microtia patients （4 cases with bilateral congenital microtia） were treated with the method mentioned above.Resul ts All patients were followed up for 1 to 18 months after reconstruction.Most cases were reported to be satisfied with the appearance of good shape,accurate size,right position and orientation,symmetric auriculocephalic angle,stable structure of reconstructed helix,scapha,antihelix,triangular fossa,tragus,auricular concha,and concealed scar in the retroauricular region.The color and texture of the reconstructed matched well.Among the 74 cases,5 cases with leakage of expander,2 cases with hematoma,3 cases with ulceration of expanded skin flap,1 case with disruption of wound and 1 case with exposure of cartilage framework.Conclusion The technique is an ideal method to treat patients with congenital microtia,who have retroauricular skin thick or have retroauricular skin thin and loose and demand less scar,by covering cartilage framework with expanded skin flap simply,obtaining erect reconstructed auricle with fine structure.Skin grafting and fascial flap are not needed anymore.In addition,advantages of the technique are simple operation,little scar.