CAJ | 학술논문

目的探讨Medpor和刃厚头皮片在先天性小耳畸形Nagata法耳廓再造耳颅沟成形中的应用方法及疗效.方法参照Nagata二期法耳廓再造程序完成一期手术,即肋软骨耳廓支架成型和移植,一期术后6个月后行二期耳颅沟成形:于患侧颞枕部获取与再造耳上部皮肤连续的刃厚皮片,翻起皮片,在再造耳外耳轮外5 mm切开达皮下层,向耳甲腔方向分离并掀起软骨支架;以C形Medpor支架支撑于再造耳支架后方,再造耳支架背面和Medpor表面行带颞浅血管的颞浅筋膜瓣覆盖,最后将刃厚头皮片覆盖于筋膜瓣表面缝合固定,湿纱卷加压固定.结果 2010年7月至2012年8月,于临床应用20例22侧,1例二期术后发现颞浅筋膜瓣部分坏死、支架外露,采用耳后筋膜瓣覆盖及刃厚头皮片移植修复.其余患者均顺利完成二期手术.随访时间为6～18个月,平均13个月,20例22只再造耳术后耳颅沟形状均满意.结论应用刃厚头皮片和Medpor材料可以获得稳定满意的耳颅沟,且既可避免切取全厚或中厚皮片在供区所遗留的明显瘢痕,又可减少因切取过多的肋软骨对胸廓的创伤.
목적 탐토Medpor화인후두피편재선천성소이기형Nagata법이곽재조이로구성형중적응용방법급료효.방법 삼조Nagata이기법이곽재조정서완성일기수술,즉륵연골이곽지가성형화이식,일기술후6개월후행이기이로구성형:우환측섭침부획취여재조이상부피부련속적인후피편,번기피편,재재조이외이륜외5 mm절개체피하층,향이갑강방향분리병흔기연골지가;이C형Medpor지가지탱우재조이지가후방,재조이지가배면화Medpor표면행대섭천혈관적섭천근막판복개,최후장인후두피편복개우근막판표면봉합고정,습사권가압고정.결과 2010년7월지2012년8월,우림상응용20례22측,1례이기술후발현섭천근막판부분배사、지가외로,채용이후근막판복개급인후두피편이식수복.기여환자균순리완성이기수술.수방시간위6～18개월,평균13개월,20례22지재조이술후이로구형상균만의.결론 응용인후두피편화Medpor재료가이획득은정만의적이로구,차기가피면절취전후혹중후피편재공구소유류적명현반흔,우가감소인절취과다적륵연골대흉곽적창상.
Objective To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method.Methods The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework.The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus.Split-thickness skin was taken from temporal and accipital area.After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework,the temporaparietal fascia flap was transferred to cover postauricular medpor and framework.Then the split-thickness skin graft was implant on the fascia surface.Results From July 2010 to August 2012,20 cases (22 ears) were treated.Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case.Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average,13 months).Conclusions The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results.It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin,but also reduces chest trauma due to harvesting costal cartilage.