CAJ | 학술논문

目的在Nagata法的基础上探索改进一种耳廓再造的方法.方法对90例小耳畸形患者(101耳)进行了二期法耳廓再造.手术分两期进行,两次手术间隔6个月.Ⅰ期采用Nagata法,应用自体肋软骨雕刻成三维支架行耳廓再造,包括自体肋软骨切取、耳支架雕刻成形、残耳的修整,将雕刻的三维耳支架埋置于乳突区皮瓣下、耳垂转位衔接于再造耳的下方等.Ⅱ期采用两瓣法耳颅角成形术,于再造耳的耳轮外缘外侧0.5 cm处设计切口,掀起再造耳,并在耳支架深面携带较厚的耳后筋膜:将Ⅰ期手术预留埋植的肋软骨作为耳后支撑支架,调节支架位置与角度,使再造耳的形态、位置、轴向等接近于健耳,并使颅耳角较对侧稍大；在再造耳廓的上方及下方乳突区各设计一个任意皮瓣,分别向颅耳沟旋转移转,将两皮瓣对位缝合,覆盖支撑软骨；皮瓣两侧创面分别植皮.结果所有患者均取得较好效果,90例患者(101耳)中96耳手术效果满意,5例患者基本满意.5只再造耳出现皮瓣尖端小面积坏死,经换药后痊愈,对手术结果无影响；2耳出现耳轮处软骨支架外露,通过转移局部皮瓣覆盖后痊愈,术后结果基本满意；4耳Ⅱ期术后出现耳颅角回缩.随访67例患者,时间3～24个月,再造耳三维立体轮廓清晰,颅耳角维持在20°～ 30°,形态稳定,效果满意.结论该改良Nagata法耳廓再造术是一种较为实用、简单易行的方法.
목적 재Nagata법적기출상탐색개진일충이곽재조적방법.방법 대90례소이기형환자(101이)진행료이기법이곽재조.수술분량기진행,량차수술간격6개월.Ⅰ기채용Nagata법,응용자체륵연골조각성삼유지가행이곽재조,포괄자체륵연골절취、이지가조각성형、잔이적수정,장조각적삼유이지가매치우유돌구피판하、이수전위함접우재조이적하방등.Ⅱ기채용량판법이로각성형술,우재조이적이륜외연외측0.5 cm처설계절구,흔기재조이,병재이지가심면휴대교후적이후근막:장Ⅰ기수술예류매식적륵연골작위이후지탱지가,조절지가위치여각도,사재조이적형태、위치、축향등접근우건이,병사로이각교대측초대；재재조이곽적상방급하방유돌구각설계일개임의피판,분별향로이구선전이전,장량피판대위봉합,복개지탱연골；피판량측창면분별식피.결과 소유환자균취득교호효과,90례환자(101이)중96이수술효과만의,5례환자기본만의.5지재조이출현피판첨단소면적배사,경환약후전유,대수술결과무영향；2이출현이륜처연골지가외로,통과전이국부피판복개후전유,술후결과기본만의；4이Ⅱ기술후출현이로각회축.수방67례환자,시간3～24개월,재조이삼유입체륜곽청석,로이각유지재20°～ 30°,형태은정,효과만의.결론 해개량Nagata법이곽재조술시일충교위실용、간단역행적방법.
Objective To investigate a method for total reconstruction of auricle.Methods 90 patients (101 ears) with congenital microtia underwent two-stage operations for auricular reconstruction.The first stage involved fabrication and grafting of autologous costal cartilage,removing the remnant ear cartilage,embedding the framework into local flap of the mastoid region,transferring the remnant ear lobule flap to link to the inferior framework.The second stage was creating an auriculocephalic sulcus.The reconstruction was performed 4-12 months after the first surgery.Skin incision was made 5 mm lateral side of the posterior margin of the auricle.The ear framework carrying a thick ear fascia was separated from the side of the head,the frames of the costal cartilage banked at the first operation were harvested,shaved and transplanted to the posterior wall of the concha with sutures; adjust stand position and angle,so that made the ear shape,position,axis,close to the healthy ear,and auriculocephalic angle was slightly larger than the contralateral ear.Two random flap was designed with superior on the root of the helix and in the inferior-posterior direction of the inferior mastoid area,two flapes were elevated and transplanted to posterior auricular sulcus to cover the grafted cartilage.Skin graft was performed in the remaining raw surface.Results A total of 90 patients were operated,all of 101 constructed ears achieved satisfied or near satisfied shapes.Five cases of partial skin flap necrosis were caused by pedicle impairment.Exposure of cartilage framework happened in two crases.The auriculocephalic sulcus of four cases diminished after the second stage operation.Three month to two-year follow-up of 67 patients showed that the reconstructed ears were satisfied with the results,including good shapes and steady auriculocephalic angles.Conclusions The method is a simple,safe and reliable method for total aural reconstruction.