颞浅动脉岛状皮瓣修复耳廓再造联合骨桥植入术后骨桥外露的临床观察

Therapeutic effect of superficial temporal island flap on bone bridge exposure after auricle reconstruction combined with bone bridge implantation

目的分析骨桥植入与Nagata耳廓再造同期手术治疗双侧外中耳畸形、外耳道骨性闭锁出现植入体外露的情况,并对运用颞浅动脉岛状皮瓣修复植入体外露的临床效果进行评价分析。方法回顾分析2017年1月~2020年12月在中国医学科学院整形外科医院和首都医科大学附属北京同仁医院合作收治的84例双侧先天性小耳畸形伴听力功能障碍患者的临床资料。其中男性61例、女性23例;年龄6~20岁,平均(8.4±2.3)岁。所有患者均接受Nagata二期法耳廓再造术,且双侧同时进行;于耳廓再造第二期手术时同期行单侧骨桥植入术。随访时间为1年,统计1年内患者出现植入体外露的情况,并运用颞浅动脉岛状皮瓣进行修复覆盖。结果共3例患者出现术后骨桥植入体外露,发生率为3.6%。运用颞浅动脉岛状皮瓣进行修复覆盖后效果良好,3例患者均一期愈合,修复后随访1年未再出现植入体外露。结论Nagata法耳廓再造与骨桥植入术同期进行,可以明显缩短手术周期,使双侧小耳畸形患者在获得良好耳廓形态的同时,听力得到明显改善。联合手术安全有效,植入体外露发生率低。颞浅动脉岛状皮瓣可以很好地填塞植入体引起的死腔,增加组织的耐磨性,可作为修复植入体外露的良好手术方案。

Objective To analyze the situation of implant exposure after auricle reconstruction with Nagata’s method and bone bridge implantation,and to evaluate the clinical effect of superficial temporal artery island flap repairing on the implant exposure.Methods The clinical data of 84 patients with congenital microtia and hearing impairment were retrospectively analyzed.The patients were admitted to the Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Beijing Tongren Hospital Affiliated to Capital Medical University from January 2017 to December 2020.There were 61 males and 23 females,aged from 6 to 20 years(8.4±2.3 years).All cases underwent bilateral Nagata auricle reconstruction simultaneously,and bone bridge implantations were performed during the second stage of auricle reconstruction.The cases of implant exposure were collected within 12 months after operation who were repaired with superficial temporal island flap.Results Three cases(3.6%)of implant exposure were observed postoperatively,and the surgical outcome was satisfactory with repairment of superficial temporal island flap.Conclusions Auricle reconstruction with Nagata’s method and bone bridge implant can be carried out as an integrated surgical procedure.It can significantly shorten the operation cycle,and the combined procedure can provide stable hearing improvement and good appearance with low incidence of implant exposure.Superficial temporal island flap is a favorable surgical method to repair implant exposure.