利用Ⅲ度小耳畸形残耳组织行再造耳耳屏及耳甲腔成形

Application of remnant ear of grade Ⅲ microtia in the reconstruction of tragus and concha cavity

目的探讨采用全扩张法对残耳组织量较少的Ⅲ度小耳畸形患者行全耳再造术,合理利用残耳组织行耳屏及耳甲腔成形。方法新方法组对36例组织量较少的Ⅲ度小耳畸形患者,一期采用经残耳切口,在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;三期时将残耳垂皮肤进行合理设计,用于再造耳屏并覆盖部分耳甲腔创面,残耳软骨用于作为耳屏的内支撑或垫于支架深面以增加支架的高度。传统扩张组46例,三期时将残耳垂转移以再造耳垂,采用M形皮瓣法再造耳屏,耳甲腔区游离植皮。三期再造耳修整后6~12个月随访,对耳屏和耳甲腔的大小及患者的满意度进行评价。结果新方法组患者术后耳郭表面均无明显切口瘢痕,仅1例患者残耳垂皮瓣远端覆盖耳甲腔部位存在约0.6 cm×0.4 cm大小皮瓣表皮水泡,经换药10 d后愈合。传统扩张组中可见5例患者耳甲腔移植皮片表面出现水泡,经换药后愈合。与传统扩张组相比,新方法组耳屏挛缩变形轻,耳甲腔回缩率小。新方法组患者满意率明显高于传统扩张组(P<0.05)。耳垂丰满度与正常耳相比略差。结论采用全扩张法可以扩张足够的皮肤,用于完全覆盖整个软骨支架的表面,无需行耳垂转位,再造耳支架表面无手术瘢痕,且残耳组织可以得到充分利用,再造的耳屏及耳甲腔外形良好。

Objective To explore the application of totally expanded skin for auricular reconstruction in patients with grade Ⅲ microtia.To reconstruct tragus and concha cavity by rational utilization of remnant ear.Methods There were 36 patients suffered from microtia with remnant ear in the new method group.In the first stage of operation,a tissue expander of 150 ml was implanted to the dual-plane of postauricular mastoid region through the incision of remnant ear.In the second stage,autologous costal cartilage framework was implanted for auricular reconstruction.In the third stage,the skin of remnant ear was designed to reconstruct the tragus and cover partial wounds of the concha cavity.The cartilage of remnant ear was used as the internal support of tragus or inserted to the bottom to increase the height of framework.There were 46 patients in the traditional expansion group.In the third stage of operation,the remnant earlobe was transferred to reconstruct earlobe.The tragus was reconstructed by Mflap.The free skin graft was applied for concha cavity.All patients were followed up from6 to 12 months,the size of tragus and concha cavity and satisfaction of patients were evaluated.Results No obvious scar was found on the surface of reconstructed auricle in the newmethod group.A blister of 0.6 cm×0.4 cm at distal remnant earlobe flap was found in 1 patient and cured after dressing change of 10 days.In the traditional expansion group,blister was found in skin graft of concha cavity in 5 patients and cured after dressing change.During the follow-up,the contracture and deformity of tragus and retraction rate of concha cavity was less than that of the traditional expansion group.The patients'satisfaction of the new method group was significantly higher than that of the traditional expansion group(P<0.05).The fullness of reconstructed earlobes was slightly worse than normal.Conclusion Enough skin could be expanded to totally covered the surface of the whole cartilage framework.There was no need for earlobe transposition.No surgical scar was found on the framework surface of the reconstructed ear.The remnant ear could be adequately used.The appearance of tragus and concha cavity of reconstructed ear was good.