脱细胞真皮及扩张皮瓣在肋软骨移植半耳缺损再造中的应用

Application of acellular dermal matrix and expanded flap in half auricular reconstruction with rib cartilage grafts

背景:外伤性耳郭上1/2或下1/2缺损,耳软骨及皮肤血管严重受累,自体肋软骨耳支架及脱细胞真皮组织相容性好,扩张皮瓣可提供菲薄无明显色差的缺失覆盖皮肤。目的:探讨脱细胞真皮及扩张皮瓣在半耳缺损再造中的应用,自体肋软骨耳支架的精细雕刻与吻合及半耳的共同特点及意义。方法:应用脱细胞真皮辅助残耳对接及颅耳角形成,采用扩张皮瓣、自体肋软骨支架移植、精细吻合软骨支架与残耳组织,行半耳缺损再造的患者8例;半耳缺损再造主要分3期:一期行耳后80 m L扩张器植入;二期耳郭再造、肋软骨支架精细雕刻置入、脱细胞真皮包裹填充、耳郭成形;三期主要行脱细胞真皮辅助耳支架及耳支架与残耳衔接细微修整以达到更好效果。采用客观测量结合主观评分的方法评价半耳缺损再造效果。结果与结论:8例半耳患者再造后均成活良好,无明显并发症发生,耳软骨支架无明显暴露;修整后持续随访,再造耳郭形态良好,与残耳对合良好,耳轮缘流畅自然,无明显色差及臃肿,位置、大小、形态与健侧基本一致。修整后6个月随访客观指标检验显示,患侧与健侧对比差异无显著性意义(P>0.05)。结果表明,应用脱细胞真皮可明显减少耳软骨支架暴露的并发症,获得较好的耳郭外形;采用扩张皮瓣、自体肋软骨支架雕刻移植、精细吻合软骨支架与残耳组织的半耳缺损再造有明显的临床效果。

BACKGROUND：Traumatic auricle defects in upper 1/2 or lower 1/2,seriously involve the auricular cartilage and skin blood vessels.The autogenic rib cartilage graft and acellular dermal matrix have good histocompatibility,and expanded flap is a kind of thin and achromatic tissue for skin defect repair.OBJECTIVE：To explore the application of acellular dermal matrix and expanded flap in half auricular reconstruction,and to find out the fine carving and anastomosis of autogenic rib cartilage graft as well as its similarities with the ear and clinical significance.METHODS：Eight cases of half auricular defects were treated with expanded flap,autogenic rib cartilage graft,fine anastomosis of autogenic rib cartilage graft and residual ear for half auricular reconstruction,during which the acellular dermal matrix was used to promote residual ear docking and skull auricle angle formation.The reconstruction was performed in three stages：first,an expander（volume,80 mL） was subcutaneously implanted at the retro-auricular area;second,the auricular defects were reconstructed with fine rib cartilage graft,acellular dermal matrix and auriculoplasty;finally,acellular dermal matrix was used to promote residual ear docking.Then the half auricular reconstruction was evaluated by objective measurement and subjective rating.RESULTS AND CONCLUSION：Half auricular reconstruction was successful in all the eight cases without obvious complications,and the cartilage grafts were in good condition.During the follow-up,the reconstructed auricle was shaped well and formed a good involution with the residual auricle.In addition,the flange was smooth without obvious color difference and edema,and its position,size and shape were consistent with those of the contralateral one.After the follow-up of 6 months,objective indicators showed that the affected side had no significant difference from the contralateral one（P〉0.05）.In conclusion,the acellular dermal matrix can obviously decrease the complications of the cartilage grafts and contribute to a good shaped auricle;and half auricular reconstruction by expanded flap,autogenic rib cartilage graft,and fine anastomosis of autogenic rib cartilage graft can achieve significant clinical effects.