耳后扩张袋状皮瓣全耳再造术

Otoplasty using expanded "bag-shape" opisthotic fascial flap

目的 探讨利用耳后扩张的袋状皮瓣行全耳再造术的效果。方法 1997年 12月至1999年 11月对 18例小耳畸形患者 ,应用耳后扩张袋状皮瓣行全耳再造术。手术分两期进行 :Ⅰ期手术在耳后皮下埋置 5 0ml肾形扩张器 ,同时行耳垂转移或旷置。Ⅱ期手术在扩张的耳后皮瓣上或下端经 2 .5～ 3.0cm切口切开取出扩张器 ,除前方为蒂部不予切开外 ,均在扩张皮瓣稍外侧约距扩张囊边缘 0 .5～ 0 .6cm处呈肾形切开直达深筋膜下层 ,由耳后筋膜深层向前锐性分离 ,形成一囊袋状一并掀起。袋内置入耳支架并固定、负压吸引、耳后全厚植皮修复。结果 用耳后扩张袋状皮瓣行全耳再造 ,简化了手术程序 ,增强了皮瓣的血液循环 ,提高了负压吸引效果 ,降低了并发症的发生率。临床应用 18例 ,效果较为满意。结论 耳后扩张袋状皮瓣全耳再造术成功率高 ,外形逼真。

Objective To make an inquiry into how to reconstruct a lifelike ear, and which is one of the most thorny problem in plastic surgery. Methods The operation was divided into two stages: the first stage was that an expander was put into a patient's opisthotic subscutaneous region and lobe of the ear was transposed or laid aside; the second stage was that the expander was taken off by a 2.5～3.0 ㎝ incision at the top or bottom of the expanded flap. The reniform incision except the preauriclar pedical part which was 0.5～0.6 ㎝ away from the expander edge was slit until the deep fascia and dissected forword at the same layer in order to form a 'bag-shape' flap. Then, an auricle model was put and fixed and aspirating tube was inserted in the 'bag'. The back of the reconstructive ear was repaired with the full thickness graft. Results It made operating procedure simple, negative pressure plasty looked good, the blood circuit of flap was increased and occurrence rate of complication reduced. The operation had been performed on 18 patients with a satisfactory results. Conclusion The success rate of the procedure is higher and the shape of the reconstructed ear is more lifelike than that of the traditional one.