扩张耳后乳突区联合双层筋膜皮瓣耳廓再造的临床效果

Joint expansion of double fascia flaps for fall-ear mastoid reconstruction

目的 探讨扩张耳后联合双层筋膜皮瓣覆盖多孔高密度聚乙烯（Medpor）支架行先天性小耳畸形耳廓再造术的临床效果.方法 选取60例先天性小耳畸形患者,左侧22例,右侧38例.临床表现大部分耳廓缺如,或仅有部分耳垂.Ⅰ期手术将颞顶筋膜瓣转移于残耳乳突区筋膜层下,与耳后筋膜皮瓣进行同步扩张;Ⅱ期手术将扩张的耳后联合双层筋膜皮瓣包裹整个Medpor支架行耳廓再造术.结果 60例患者外耳廓再造术后皮瓣均成活,均Ⅰ期愈合,无并发症发生.术后随访3个月至3年再造耳廓形态良好,微细解剖结构清晰,颅耳角位置大小均与健耳基本一致.无1例支架外露及瘢痕挛缩,三维立体外形逼真,再造耳形态满意.结论 采用扩张耳后联合双层筋膜皮瓣覆盖Med-por支架行耳廓再造术,能有效地避免传统术胸壁畸形及支架外露弊端,再造耳微细形态结构满意.

Objective To study the methods and clinical effects of joint expansion of double fascia flaps wrapping the Medpor to perform full-ear reconstruction on congenital microtia deformity.Methods 60 patients with congenital microtia deformity were selected.including 22 left ears and 38 right ears.Majority had loss of ear auricle or only partial earlobe.Phase Ⅰ procedures included：temporal-parietal branch was used for the vascular pedicle,and mastoid area behind the ear was moved and expanded for fascia flap.Phase Ⅱ included：the joint expansion of double fascia flap wrapped Medpor to do full-ear reconstruction.Results Flaps survived and no complications for all 60 patients.Reconstructed ears had lifelike appearance and clear anatomical structures.Auriculocephalic angulars positions and sizes were consistent with the healthy ears.None of them had exposed prosthesis and scar contraction.Three-dimensional shapes were good.Conclusions Joint expansion of double fascia flap wrapping Medpor could avoid the chest wall deformity and exposed prosthesis.The fine structure of the reconstructed ear is satisfactory.