经残耳切口双平面埋置大容量扩张器行全耳再造术

Total auricular reconstruction with single big expander at dual plane through incision at remnant ear

目的 探讨经残耳切口双平面埋置大容量扩张器行全耳再造术的方法,以及优缺点和可行性.方法 对52例小耳畸形患者,一期采用经残耳切口,于耳后无发区浅筋膜深面及有发区浅筋膜浅层双平面埋置大容量扩张器（150 ml）,二期行自体肋软骨支架、无需植皮的全扩张法全耳再造术,同时与采用耳后乳突区浅筋膜表面埋置大容量扩张器的32例患者做对照.通过对2组患者二期再造前扩张器下移的距离、三期颅耳沟外形及并发症的发生率等的分析比较,评价该手术的效果.结果 双平面组术后扩张器下移距离为（0.7 ±0.3）cm,明显小于对照组的（1.3±0.4） cm,且差异有统计学意义（P＜0.05）.二期术后6～12个月,双平面组5例颅耳沟浅显,而对照组颅耳沟浅显12例,均经颅耳沟切开松解植皮后与对侧基本对称.结论 该方法可明显减少大容量扩张器下移的距离,使得上部皮肤得到充分的扩张,再造耳上部颅耳沟外观更佳.

Objective To investigate the feasibility and advantages of total auricular reconstruction with single big expander at dual plane through incision at remnant ear.Methods 52 patients with microtia were treated.Through incision at remnant ear,one big expander（150 ml）was implanted in the postauricular area beneath the superficial facial in the hairless area,and above the superficial fascia in the area with hair.In the second stage,total auricular was reconstructed with autologous cartilage framework and expanded skin.Skin graft was not necessary.Another 32 paitents with single big expander above the superficial fascia were used as control.The downward shift distance of expanders,the appearance of auriculocephalic sulcus and complication were recorded in order to assess the effect of these two methods.Results The downward shift distance of expanders in the dual plane group （0.7 ± 0.3） cm were lower than that in the control group（1.3 ±0.4） cm,showing significant difference （P 〈0.05）.After a follow-up period of 6-12 months,shallow auriculocephalic sulcus was presented in 5 patients of the dual plane group and 12 patient of the control group.The shallow auriculocephalic sulcus was cut to make it deeper and covered with full skin graft.Conclusions Dual plane skin expansion could reduce the downward shift distance of expander.Adequate skin on the upper part of expander could make satisfactory auriculocephalic sulcus.