结合Nagata法与皮肤扩张技术的新型耳郭再造术

The clinical application of the Nagata technique for combing tissue expansion in total auricular reconstruction

目的探讨Nagata技术及皮肤扩张技术在耳郭再造中的临床应用效果。方法手术分两期完成:一期耳后扩张器置入术;二期扩张器取出,肋软骨切取,耳郭支架雕刻,扩张皮瓣包裹耳郭支架,并进行耳垂转位,耳屏再造。结果本组26例患者,术后随访6～24个月,1例出现耳垂远端缺血;1例出现耳甲腔皮肤缺血;2例要求进一步手术;其余22例患者均获得较满意效果。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。结论结合Nagata法与皮肤扩张技术的新型耳郭再造术,可以充分利用组织扩张技术及Nagata技术的优点,缩短了治疗周期,无需耳后筋膜瓣及皮片移植,且创伤较小,瘢痕较少,是耳郭再造较理想的方法之一。

Objective To explore the clinical application of the Nagata technique for combing tissue expansion in auricular reconstruction. Methods The auricular reconstruction was performed in two surgical stages. At the first stage, an expander of 80 ml was inserted in the retroarticular mastoid region. At the second stage, after the expander was removed, the autogenous costal cartilage was harvested and the auricular framework was sculptured. The auricular framework was then wrapped by expanded skin flap, while tragus construction, lobule transposition, and concha excavation were performed at the same time. From 2012 to 2016, 26 ears from 26 congenital microtia patients underwent auricle reconstruction with the method mentioned above. Results All patients were followed up from 6 to24 months after reconstruction. Most patients reported satisfaction with good shape, accurate size, correct position and orientation, symmetric auriculocephalic angle, stable structure of the reconstructed helix, scapha, antihelix, triangular fossa, tragus, auricular concha, and concealed scar in the retroauricular region. Among the 26 cases, ischemia of the distal ear lobe occurred in one case, ischemia of the skin of the concha cavity occurred in a second case, and two patients needed further operations. Conclusion The Nagata technique for combing tissue expansion is an ideal method to treat patients with congenital microtia. This method can shorten treatment time, with no need for retroarticular fascia flap and skin graft transplantation, and with less trauma and scar.