极低发际线小耳畸形耳廓再造方案

Application of different auricular reconstruction methods in congenital microtia with low hairline

目的:探讨根据耳后乳突区皮肤条件及颞骨发育程度,对极低发际线小耳畸形患者采用不同的方案完成耳廓再造的效果。方法:回顾性分析2014年1月至2019年6月于中国医学科学院整形外科医院收治的极低发际线先天性小耳畸形患者的临床资料。耳廓再造方案:颞骨发育尚可且皮肤偏薄及弹性较差者,采用耳后皮肤扩张结合激光脱毛法;颞骨发育尚可且皮肤较厚及皮肤松弛者,采用筋膜皮瓣扩张结合激光脱毛法;颞骨发育较差者,采用颞顶筋膜结合Medpor耳支架一次再造法。术后对所有患者进行随访,调查其对再造耳的三维结构及局部亚单位形态满意度,并记录并发症情况。结果:共纳入68例患者,男55例,女13例,年龄5~22岁,平均10.4岁。其中22例采用耳后皮肤扩张结合激光脱毛法,41例采用耳后筋膜皮瓣扩张结合激光脱毛法,5例采用颞顶筋膜瓣结合Medpor耳支架一次再造法。术后随访10~24个月,平均13个月,66例再造耳的三维结构及局部亚单位形态良好,术区恢复较好,无明显瘢痕增生,未见明显胸廓畸形,其中6例激光脱毛治疗后仍残留少量毛发,经再次脱毛治疗后达到满意效果,患者满意率达到97.1%(66/68);2例采用耳后皮肤扩张结合激光脱毛方法再造耳廓的患者术后出现了软骨外露,经再次以颞顶筋膜瓣修补后痊愈。未出现头皮下血肿、植皮成活不良、软骨吸收、变形等其他并发症。结论:根据极低发际线患者耳后乳突区皮肤条件及颞骨发育程度,采用不同的治疗方案,可获得较好的耳廓形态,提高术后患者满意度,减少并发症的发生。

Objective To investigate the effect of different strategies on auricle reconstruction in microtia with very low hairline according to the skin condition of retroauricular mastoid region and the degree of temporal bone development.Methods The clinical data of patients with very low hairline congenital microtia admitted to the Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2014 to June 2019 were retrospectively analyzed.Surgical plan:the patients with moderate temporal bone development and thin and poor elasticity skin were treated with retroauricular skin expansion combined with laser hair removal;the patients with moderate temporal bone development and thick and loose skin were treated with fasciocutaneous flap expansion combined with laser hair removal;the patients with poor temporal bone development were treated with temporal superficial fascia combined with Medpor frame for one-time reconstruction.All patients were followed up to investigate their satisfaction with the three-dimensional structure and subunit morphology of the reconstructed ear,and the complications were recorded.Results A total of 68 patients,55 males and 13 females,aged from 5 to 22 years old,with an average of 10.4 years old,were included in this study.Among them,22 patients were treated with retroauricular skin expansion combined with laser hair removal,41 patients were treated with retroauricular fasciocutaneous flap expansion combined with laser hair removal,and 5 patients were treated with temporoparietal superficial fascia combined with Medpor frame for one-stage reconstruction.The follow-up ranged from 10 to 24 months(average 13 months).The three-dimensional structure and local subunits of 66 cases of reconstructed ears were in good shape,and the operation area recovered well without obvious scar hyperplasia and chest deformity.Among them,6 patients remained a small amount of hair after laser hair removal treatment,and the satisfactory effect was achieved after re-hair removal treatment.The satisfaction rate of patients was 97.1%(66/68).Two cases of auricle reconstruction by retroauricular skin expansion combined with laser hair removal showed cartilage exposure after operation,and recovered with temporoparietal fascial flap after.No subcutaneous hematoma,poor skin graft survival,cartilage absorption,deformation and other complications occurred in all cases.Conclusions According to the skin condition and temporal bone development degree of patients with very low hairline,different treatment schemes can obtain better auricle shape,improve postoperative patient satisfaction and reduce complications.