雕刻—拼接法制作自体肋软骨耳支架

Carving-Assembling Method For Autologous Costal Cartilage Ear Framework Fabrication

目的 探索一种自体肋软骨耳支架的雕刻—拼接制作方法,以期获得良好的再造耳形态。方法 2011年1月至2012年1月,共行545侧外耳再造术。应用改良Nagata法耳再造术285例,扩张皮瓣法260例。切取第6-8肋软骨,分2-3层雕刻、拼接耳支架,构建耳轮、对耳轮、耳舟、三角窝、对耳轮上脚、耳屏、对耳屏、耳甲腔等耳廓亚结构,用于外耳再造术。结果 术后有6例因局部皮肤坏死致耳支架外露,经再次手术处理后愈合;1例因感染取出肋软骨支架,6个月后再次行外耳再造术。本组患者术后随访6-12个月,488例再造耳廓形态良好,效果满意;80例再造耳廓亚结构欠清晰,效果欠佳;另有19例失访。结论 用雕刻—拼接法制作自体肋软骨耳支架,可获得结构稳固、形态逼真的支架,是耳再造获得良好效果的必要步骤。

Objective To explore a carving-assembling method to fabricate an autologous costal cartilage framework for auricular reconstruction. Methods From Jan. 2011 to Jan. 2012, 545 cases received auricular reconstruction. Among all the cases, 285 cases were treated with modified Nagata method, others with expanded retroauricular flap. Ear framework was fabricated in layers using splicing method with 6th to 8th costal cartilage. The framework includes helix, antihelix, scapha, triangular fossa, superior crus of antihelix, tragus, antitragus and concha. Results Six costal frameworks exposed due to local flaps necrosis. Because of infection, 1 case of framework was removed and re-implanted to the ipsilateral chest. All the patients were followed up for 6-12 months. Among them, 488 cases of reconstructed ears obtained vivid details with symmetric size and position, 80 cases of reconstructed ears had undesirable details. Nineteen cases lost to follow-up. Conclusion Fabricating tridimensional autologous costal cartilage framework by carving-assembling methods is safe, stable and practical. It could be an ideal method for auricular reconstruction.