中华整形外科杂志
中華整形外科雜誌
중화정형외과잡지
CHINESE JOURNAL OF PLASTIC SURGERY
2012年
2期
115-119
,共5页
小耳畸形%软组织扩张术%耳廓再造术
小耳畸形%軟組織擴張術%耳廓再造術
소이기형%연조직확장술%이곽재조술
Microtia%Soft tissue expansion%Reconstruction of auricle
目的 探讨一期采用大容量扩张器或双扩张器重叠扩张,二期无需植皮进行耳廓再造的方法,并评价其临床效果.方法 2006年1月至2010年1月,对15例Ⅱ或Ⅲ度小耳畸形的患者,采用一期在耳后区上、下重叠各埋植1个扩张器(50和70 ml)的重叠扩张,常规注水扩张；13例Ⅰ度小耳畸形及3例Ⅱ或Ⅲ度小耳畸形患者,采用1个100 ml扩张器,适当超量扩张.二期取出扩张器,以自体肋软骨或Medpor材料作为支架,筋膜瓣包裹支架,设计上部扩张皮瓣覆盖支架前侧及后侧上部,下部扩张皮瓣覆盖支架后侧下部,残余扩张皮瓣向下推行转移后覆盖耳后颅侧壁创面.结果 所有患者术中均无需另取皮片移植,术后再造耳轮廓清晰,形状逼真,无感染及支架外露等并发症,1例耳后皮瓣远端出现约0.5 cm ×0.5 cm表皮水泡,经换药后愈合.随访6～ 12个月,患者胸部供区切口瘢痕面积为(5.2±0.6)cm2,无明显并发症发生,31例患者中有28例对再造耳外观满意或比较满意,满意率为90％ (28/31).结论 该方法可以扩张出足够的皮肤组织,在二期耳再造时,通过合理设计扩张皮瓣而覆盖耳后创面,无需植皮,并发症少,软骨供区瘢痕明显减小.
目的 探討一期採用大容量擴張器或雙擴張器重疊擴張,二期無需植皮進行耳廓再造的方法,併評價其臨床效果.方法 2006年1月至2010年1月,對15例Ⅱ或Ⅲ度小耳畸形的患者,採用一期在耳後區上、下重疊各埋植1箇擴張器(50和70 ml)的重疊擴張,常規註水擴張；13例Ⅰ度小耳畸形及3例Ⅱ或Ⅲ度小耳畸形患者,採用1箇100 ml擴張器,適噹超量擴張.二期取齣擴張器,以自體肋軟骨或Medpor材料作為支架,觔膜瓣包裹支架,設計上部擴張皮瓣覆蓋支架前側及後側上部,下部擴張皮瓣覆蓋支架後側下部,殘餘擴張皮瓣嚮下推行轉移後覆蓋耳後顱側壁創麵.結果 所有患者術中均無需另取皮片移植,術後再造耳輪廓清晰,形狀逼真,無感染及支架外露等併髮癥,1例耳後皮瓣遠耑齣現約0.5 cm ×0.5 cm錶皮水泡,經換藥後愈閤.隨訪6～ 12箇月,患者胸部供區切口瘢痕麵積為(5.2±0.6)cm2,無明顯併髮癥髮生,31例患者中有28例對再造耳外觀滿意或比較滿意,滿意率為90％ (28/31).結論 該方法可以擴張齣足夠的皮膚組織,在二期耳再造時,通過閤理設計擴張皮瓣而覆蓋耳後創麵,無需植皮,併髮癥少,軟骨供區瘢痕明顯減小.
목적 탐토일기채용대용량확장기혹쌍확장기중첩확장,이기무수식피진행이곽재조적방법,병평개기림상효과.방법 2006년1월지2010년1월,대15례Ⅱ혹Ⅲ도소이기형적환자,채용일기재이후구상、하중첩각매식1개확장기(50화70 ml)적중첩확장,상규주수확장；13례Ⅰ도소이기형급3례Ⅱ혹Ⅲ도소이기형환자,채용1개100 ml확장기,괄당초량확장.이기취출확장기,이자체륵연골혹Medpor재료작위지가,근막판포과지가,설계상부확장피판복개지가전측급후측상부,하부확장피판복개지가후측하부,잔여확장피판향하추행전이후복개이후로측벽창면.결과 소유환자술중균무수령취피편이식,술후재조이륜곽청석,형상핍진,무감염급지가외로등병발증,1례이후피판원단출현약0.5 cm ×0.5 cm표피수포,경환약후유합.수방6～ 12개월,환자흉부공구절구반흔면적위(5.2±0.6)cm2,무명현병발증발생,31례환자중유28례대재조이외관만의혹비교만의,만의솔위90％ (28/31).결론 해방법가이확장출족구적피부조직,재이기이재조시,통과합리설계확장피판이복개이후창면,무수식피,병발증소,연골공구반흔명현감소.
Objective To investigate a methad of auricular reconstruction by soft tissue expansion techniques without skin grafting.Methods Two tissue expanders (50 ml and 70 ml) were implanted under the skin of mastoid in 15 patients with grade Ⅱ or Ⅲ microtia. One big expander(100ml) were implanted under the skin of mastoid in 13 patients with grade Ⅰ microtia and 3 patients with grade Ⅱ or Ⅲ microtia.After skin expansion,the expanders were taken out. The autologous rib cartilage or Medpor scaffolds were implanted.The superior expanded skin flap was used to cover the frontal surface and the upper part of the back surface of the framework.The inferior expanded skin flap was transplanted to cover the lower part of the back surface of the framework.The remained expanded skin flap was transplanted to cover the wound in the lateral of head.Results No skin graft was needed in all the patients.Epidermis blister occurred at the distal part of flap in one case.No other complication was happened.A follow-up of 6 to 12 months ( mean 10.9 months) was carried out in all patients with good cosmetic result when the reconstructed ear underwent second-stage operation.The scar size on the dornor site was (5.2 ± 0.6) cm2.The satisfactory rate was 90％ (28/31).Conclusions The expanded skin with this new method is enough for auricular reconstruction without skin grafting,leaving less complication and less scar at donor site.
