颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架外耳再造术

目的探讨颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架再造外耳的效果。方法手术分两期进行:一期手术在乳突区置入皮肤软组织扩张器,并定时注水扩张;第二期手术将扩张器取出并形成蒂在前的扩张皮瓣、掀起以颞浅血管为蒂的颞顶筋膜瓣,应用颞顶筋膜瓣和乳突区扩张皮瓣双重由里至外覆盖Medpor耳支架完成耳廓再造。结果临床应用22例,随访半年至2年半,无耳支架外露发生,再造的耳廓外形逼真,轮廓分明,肤色与周围正常皮肤一致。结论应用乳突区扩张皮瓣及颞顶筋膜瓣双层组织瓣包被Medpor耳支架,可以提高Medpor耳支架置入的安全性,避免发生外露,又不影响支架外形和轮廓的显现,再造耳表面皮肤的色泽与周围皮肤一致。     

Medpor外耳再造术皮肤覆盖方案的临床研究

目的:本文通过比较几种不同的支架外皮肤覆盖方案,探索一种手术效果稳定可靠的合成材料支架外耳再造方法。方法:48例先天性小耳畸形,应用Medpor支架行全外耳再造术,支架外软组织覆盖材料分别为单纯乳突区扩张皮肤1例、颞顶筋膜瓣加植皮25例、乳突区扩张皮瓣加颞顶筋膜瓣22例,观察比较应用不同覆盖材料耳再造后支架外露发生率、再造外耳外形轮廓、表面皮肤颜色质地。结果:临床应用48例,随访1至6年,应用单纯乳突区扩张皮瓣覆盖者1年内耳支架完全外露;应用颞顶筋膜瓣加植皮者再造耳廓外形及轮廓优良,但大部分病例再造耳廓皮瓣不同程度色素异常;应用乳突区扩张皮瓣及颞顶筋膜瓣联合覆盖者再造外耳形态及轮廓均优良,且表面皮瓣颜色质地与周围皮肤和对侧外耳皮肤一致,美容效果最佳。结论:应用乳突区扩张后皮瓣及颞顶筋膜瓣双层组织瓣的软组织覆盖方案可以满足Medpor再造外耳的外形、轮廓及皮色的需求,是一项安全稳定的手术方案,综合效果优于颞顶筋膜瓣加植皮方案,而单纯应用乳突区扩张皮瓣的方案不适用于Medpor外耳再造术。因此推荐在选用Medpor耳支架行全外耳再造治疗Ⅲ度先天性小耳畸形时,优先选用颞顶筋膜瓣联合乳突区扩张皮瓣的软组织覆盖方案。     

耳后联合双层筋膜瓣Medpor支架全耳再造的临床研究

目的:探讨采用颞顶筋膜瓣与耳后筋膜皮瓣(简称:耳后联合双层筋膜瓣),Medpor支架行先天性小耳畸形全耳再造术的方法和效果。方法:采用颞顶支为血管蒂的岛状筋膜瓣移转至残耳乳突区耳后,与耳后乳突区筋膜皮瓣同期同步进行扩张,然后将扩张的耳后联合双层筋膜皮瓣包裹Medpor支架行全耳廓再造。结果:本组患者中经3个月~3年的随访,再造耳皮肤颜色与耳周缘面部相接近,微细结构清晰,颅耳角与健耳对称,形态结构好。结论:耳后联合双层筋膜瓣+Medpor支架行全耳廓再造,既能有效避免支架外露和传统手术供区胸壁畸形,又能避免切取自体肋软骨增加的创伤及痛苦。再造耳皮肤颜色与正常肤色相似,形态满意,是一种值得推广的手术方法。     

耳后联合筋膜皮瓣全耳廓再造的临床研究

目的：探讨颞顶筋膜瓣、耳后筋膜瓣两瓣（简称：耳后联合筋膜瓣）包裹Medpor支架行先天性小耳畸形全耳再造术的方法和效果。方法：手术分为两期：I期采用颞浅动静脉顶支为血管蒂的岛状筋膜瓣,植入残耳乳突区耳后剥离的皮下腔穴,然后植入皮肤扩张器与耳后筋膜皮瓣进行同期同步扩张;II期取出扩张器,将扩张耳后联合筋膜皮瓣包裹Medpor支架行全耳廓再造术。结果：38例患者中,经6个月～3年的随访,再造耳形态结构稳定,颜色与周围皮肤相近,微细结构清晰,颅耳角良好与健耳对称。结论：该方法既可解决覆盖支架的难题,又将手术并发症减少到最低限度,避免支架外露。是目前较为理想的全耳廓再造术的一种新方法。     

获得性耳廓缺损的修复

目的探讨获得性耳廓缺损的手术修复方法。方法采用组织扩张器结合自体肋软骨支架移植或Medpor支架置入、耳赝复体等多种方法进行修复。结果长期随访观察,再造耳廓皮瓣色泽红润、柔软、感觉功能无明显异常;移植耳廓软骨支架无软化、吸收、变形;Medpor支架偶有外露;再造耳廓位置、形态、大小和对侧基本一致;耳赝复体外形佳,固定牢靠。结论组织扩张器结合自体肋软骨支架移植的方法,疗效满意、并发症少,是获得性耳廓缺损的主要治疗方法;组织扩张器结合Medpor支架置入和耳赝复体制作治疗是其有益的补充。     

多孔高密度聚乙烯支架在皮肤破溃感染的全耳廓再造术中的应用

目的对于先天性小耳患者，在应用扩张法行外耳再造术的过程中，当耳后皮肤软组织在扩张阶段发生扩张皮肤破溃，以致继发感染后，探索一种较为可行的外耳再造方法。方法对26例耳后扩张皮肤发生破溃感染的先天性小耳患者，经过积极的全身抗感染和适宜的局部换药处理，在感染得到有效控制后，应用多孔高密度聚乙烯（porous high density polyethylene，Medpor）材料做支架，外包蒂在前的耳后乳突区皮下组织筋膜瓣、扩张皮肤及移植皮片，行外耳再造术。结果26例外耳再造手术均获成功，耳形态令人满意，轮廓清晰。结论在耳后皮肤软组织扩张阶段，当扩张皮肤发生破溃继发感染后，用Medpor支架代替自体肋软骨支架行外耳再造术，是一种较为安全可行的手术方法。     

乳突区双扩张器重叠埋置在全耳廓再造术中的应用

目的 介绍应用两个皮肤软组织扩张器叠加埋置的方法进行全耳廓再造的临床经验。方法 自2008年1月至2011年12月,共27例小耳畸形患者实施该方法。一期手术在患侧乳突区埋置肾形皮肤软组织扩张器80 mL（或100 mL） 和50 mL 各一个,将体积大的扩张器叠加放置在体积小的扩张器之上,术后定期交替扩张器注水3～6月。二期手术全部采用Medpor人工耳廓支架,取出扩张器,将扩张的皮瓣直接包裹支架,负压维持耳廓成形。结果 随访时间4～50月,27例再造的耳廓外形位置良好,皮肤质地与周围皮肤相近,颅耳沟稳定无回缩,扩张皮瓣无坏死。2例患者因伤口裂开发生耳廓支架外露(7.4%),进行一次修补手术后恢复良好。结论 乳突区叠加埋置两个扩张器全耳廓再造术,避免了植皮,不再使用耳后筋膜瓣和颞筋膜瓣,手术过程简单化,缩短了手术时间,部分再造耳廓亚单位欠清晰,但总体效果满意。     

多孔高密度聚乙烯应用于扩张法耳廓再造术的临床研究

目的探讨应用多孔高密度聚乙烯（Medpor）作为再造耳支架对先天性小耳或后天耳廓缺失患者进行再造的可行性。方法1999年2月-2004年2月收治61例耳廓缺失患者，男38例，女23例；年龄5～61岁。先天性小耳40例，其中双侧1例，单侧39例．外伤后耳廓缺损21例，其中双侧6例，单侧15例。应用耳后软组织扩张法，以Medpor为支架行耳廓再造术。手术分二期，一期为耳后皮肤软组织扩张器置入术；二期为耳廓再造术。以耳后扩张皮瓣或扩张的耳后瘢痕瓣和乳突区皮下组织筋膜瓣包裹Medpor支架，再造耳廓。结果61例耳廓再造术患者均痊愈出院，获随访6个月～5年1个月，平均2．8年。其中49例（80．3％）患者对手术结果满意，7例（11．5％）认为再造耳手术效果尚可，3例（4．9％）发生了支架外露，对手术效果不满意，2例（3．3％）于术后6个月行自体肋软骨移植，置换Medpor支架。结论扩张法耳廓再造术中，对不适合、不能或不愿取用自体肋软骨作为再造耳支架的患者，应用Medpor耳支架，是一种较为安全、简便及可行的方法。     

双扩张器重叠扩张无需植皮的全耳成形术

目的 探讨一期采用双扩张器重叠扩张,二期无需植皮进行全耳成形术的方法,并总结其优缺点及适应证.方法 对6例先天性小耳畸形患者,采用一期在耳后区上、下重叠各埋置1个扩张器,常规注水扩张.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,向下推进转移后覆盖耳后颅侧壁创面.同时采用传统扩张法行全耳成形术13例作为对照.结果 所有患者术中均无需另取皮片移植,术后所造外耳轮廓清晰,形状逼真,无感染及支架外露等并发症发生,仅1例耳后皮瓣远端约0.5 cm×0.5 cm表皮坏死,经换药后愈合.术后随访3～6个月,采用双扩张器重叠扩张组患者,利用胸部切取肋软骨切口作为皮片的供区切口瘢痕明显较单扩张器传统扩张法为小(P<0.05);并发症的发生率明显低于单扩张器传统扩张法组(P<0.01),患者的满意率也高于单扩张器传统扩张法组(P<0.05),但在成形的外耳耳轮上后部可见少许毛发生长.结论 双扩张器重叠扩张法可以扩张出足够的皮肤组织,在二期耳成形术时,通过精心合理设计扩张皮瓣覆盖耳后创面,无需植皮,切取软骨部的供区瘢痕明显减小,支架外露及感染等并发症的发生率也明显降低.     

小耳畸形的“二期法”耳廓再造术

目的探讨"二期法"行耳廓再造术的临床应用。方法第1期手术:切取右侧第6～8肋软骨,制成具有三层结构的自体肋软骨支架;应用"双瓣"技术,以残耳根部为蒂,将后方乳突区无毛发的皮肤掀起,形成皮瓣,耳后筋膜瓣的范围扩大至发际线内3.5～4 cm,呈半圆形。将肋软骨支架移植于"双瓣"之间,进行耳廓再造。第2期:利用剩余的残耳组织,重建耳轮脚、耳屏和耳甲腔等耳廓亚解剖结构。将残耳上半部制成"V"形耳轮脚皮瓣;将中部残耳组织制成半圆形耳屏皮瓣。同时将上半部残耳软骨雕刻成圆锥状,与再造耳的耳轮末端缝合固定,耳轮脚皮瓣转位覆盖,形成耳轮脚;将中部残耳软骨修剪成半圆形,用耳屏皮瓣包裹再造耳屏。切除耳甲内多余组织,进行加深,创面植皮覆盖。结果 2007年至2010年,采用"二期法"实施耳廓再造71例。经过0.5～3年随访观察,再造耳位置适当,大小与健侧基本一致;皮肤颜色与面部接近,随时间延长皮肤感觉逐渐恢复;支架无吸收及变形,再造耳廓的立体结构良好、外形自然;颅耳角与对侧相似,耳后瘢痕不明显。结论 "二期法"耳廓再造术简便易行,并发症少,易于推广应用。     

Aesthetic microtia reconstruction with Medpor

The complex architecture of the auricle makes it one of the most challenging structures for the reconstructive surgeon to re-create. Overlying the ear's unique cartilage framework are layers of varied soft tissues forming a three-dimensional organ, which is distinctively positioned on the head. Arguably, the most challenging auricle to reconstruct is third-degree microtia due to a near-total absence of native tissue and a need for lifelong durability of the reconstruction. Many methods of reconstruction have been studied; autogenous costal cartilage reconstruction has been one of the more traditional methods, with favorable long-term results reported by several surgeons. However, this technique requires tremendous artistic and technical skill on the part of the surgeon-sculptor to construct a realistic-appearing ear. High-density porous polyethylene (Medpor) is a stable, alloplastic implant that can integrate with host tissues, is resistant to infection, and has been successfully applied to reconstruction of the head and neck. For auricular reconstruction, Medpor--enveloped in a temporoparietal fascial flap with full-thickness skin graft coverage--is a durable and aesthetically gratifying alternative in microtic patients. This alternative surgical technique reduces surgical time and morbidity, standardizes results among surgeons, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.     

预制扩张耳后乳突区复合筋膜皮瓣在全耳再造中的应用研究

目的：研究采用预制扩张耳后乳突区复合筋膜皮瓣行全耳廓再造的方法和效果。方法：手术分二期完成。I期手术：设计带有颞浅动静脉蒂的颞顶筋膜瓣,移植入残耳乳突区皮下腔穴,然后置入皮肤扩张器,与耳后皮瓣进行同时同步扩张I;I期手术：将预制扩张的耳后乳突区复合筋膜皮瓣掀起,覆盖于Medpor支架上,进行全耳廓再造术。结果：36例患者经6个月～3年的随访,再造耳廓外形逼真,立体感强,与周围皮肤颜色相同,微细结构清晰。结论：采用预制扩张的耳后乳突区复合筋膜皮瓣＋Medpor支架行全耳再造,具有创伤小,操作方便,效果满意。既可避免支架外露,又可避免取自体肋软骨增加的创伤和痛苦或肤色差异等优点,是目前全耳廓再造术较为理想的选择方法。     

“单瓣扩张法”耳郭再造术的临床应用

目的 探讨“单瓣扩张”技术在耳郭再造中的临床应用.方法 手术分3期完成：Ⅰ期耳后扩张器置入术;Ⅱ期扩张器取出,肋软骨切取,耳郭支架雕刻,扩张皮瓣包裹耳郭支架;Ⅲ期再造耳修整,耳屏再造,耳垂转位,耳甲腔加深.自2012年6月至2014年1月,对74例小耳畸形患者行“单瓣扩张法”耳郭再造术.结果 所有患者随访1 ～ 18个月,5例扩张器渗漏,2例血肿,3例扩张皮肤破溃,1例伤口裂开,1例软骨外露;其余患者获满意效果,再造耳形态结构稳定,位置、大小、方向、耳颅角高度与健侧耳基本对称,耳轮、耳舟、对耳轮及其上下脚、三角窝、耳屏、耳甲腔等结构清晰自然,再造耳前后色泽、质地一致,耳后瘢痕不明显.结论 “单瓣扩张法”耳郭再造术是利用耳后扩张皮瓣包裹耳支架,无需筋膜瓣和皮片移植,即可形成结构清晰自然、稳定竖立的再造耳;手术过程简单,创伤较小,瘢痕较少.为耳后皮肤厚或者耳后皮肤松、薄的小耳畸形患者提供了一种较理想的治疗方法.     

颞顶筋膜瓣包裹Medpor全外耳一期成形术

目的：探索一种能获得理想外形、手术简便的一期全外耳成形术。方法：应用Med-por材料作支架，外包颞顶筋膜瓣和移植皮片。结果：19例耳成形均告成功，经过1-2个月水肿消退后，成形耳外形逼真，轮廓清晰。结论：Medpor支架性质稳定，易于雕塑成形，能赋予成形耳较好的外形，而颞顶筋膜瓣具有丰富的血供和坚韧的生物力学特性，将两者结合应用于耳再造手术中，使外耳成形术成为一项相对简便和安全的手术。     

Elevation of a constructed auricle using the anteriorly based mastoid fascial flap.

Two-stage methods for reconstruction of congenital microtia have been widely utilised. To obtain a desirable auriculocephalic angle and provide a nutrient support to the constructed auricle, elevation of reconstructed ears using a costal cartilage graft, the anteriorly based mastoid fascial flap transfer and a skin graft was performed as the second operation for nine microtia patients. In this procedure, the mastoid fascial flap was used instead of the temporoparietal fascial flap. Following the elevation of the reconstructed ear the anteriorly based mastoid fascial flap was harvested. A carved costal cartilage was grafted at the posterior wall of the concha and covered with the mastoid fascial flap, followed by a full-thickness skin graft from the inguinal region. The skin grafts took well and the appropriate auriculocephalic angle was preserved in all cases. This method was easy to perform and did not leave any scar in the temporal hair-bearing area.     

应用扩张的颞部瘢痕皮瓣＋Medpor耳支架行全耳郭再造

目的 探讨利用扩张的颞部瘢痕轴型皮瓣＋ Medpor耳支架行全耳郭再造的效果.方法 自2005年1月至2010年12月,共收治3例患者,均为男性;年龄22～ 30岁.头面部均为火焰严重烧伤并遗留颞部萎缩性瘢痕,同侧残耳皱缩、形态消失.采用Ⅰ期瘢痕头皮下置入皮肤软组织扩张器,注水扩张过程完成后,Ⅱ期行携带颞浅动静脉血管的颞部瘢痕轴型皮瓣＋Medpor耳支架方法行全耳郭再造.结果 3例手术均成功,虽然出院时耳郭臃肿,形态不明显,但术后随访6～12个月,扩张的瘢痕皮瓣已调整,再造塑形耳外形轮廓良好.结论 利用扩张的颞部瘢痕轴型皮瓣＋Medpor耳支架行全耳郭再造,效果良好,但遗留瘢痕外观为其不足.     

Total auricular reconstruction without skin grafting

Successful ear reconstruction depends on two factors: an ear framework and the skin covering the framework. However, the relative deficiency of skin for coverage of the cartilage framework remains an issue. This new method for total auricular reconstruction is a three-stage operation and involves the use of two tissue expanders. First, two skin expanders are implanted, one underneath the scalp and the other sited behind the microtic ear. At the second stage, after lobule transposition, the two expanded skin flaps (upper and lower) and mastoid fascial flap are raised. At the same time, the autogenous rib cartilage is harvested and the framework constructed. The cartilage framework is then anchored between the upper expanded skin flap and the fascial flap with its inferior pole inserted into the rotated earlobe. The upper expanded skin flap covers the whole anterior surface of the framework and drapes over the margins of the fascial flap, which wrap the framework from beneath. The raw surface of fascial flap is covered with the lower expanded skin flap. The formation of a pseudomeatus and tragus is performed at the third stage. Deficiency of skin is the major problem encountered with the other conventional methods. Our innovations using two tissue expanders in combination with an autogenous rib cartilage framework eliminate this problem completely.     

A new skin flap method for total auricular reconstruction: extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap: four skin flaps and temporoparietal fascia flap

A sufficient skin envelope of good quality as well as definite auricular framework is a prerequisite for a successful auricular reconstruction. Various surgical techniques, such as recruitment of mastoid skin, skin graft, tissue expansion, and so on, have been used to get the necessary skin for covering of the auricular framework. However, debates about the drawbacks of these techniques have continued. In this article, I report on a new skin flap method for total auricular reconstruction, which is an extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap. Between January 2009 and March 2010, a total of 20 patients underwent an auricular reconstruction using a Medpor framework (Porex Surgical, Inc, Newnan, GA) and the new skin flap method. Follow-up time range was 4 to 17 months. The reconstructed ear showed no definite true hair growth except for some fine hair, which can be ignored. More favorable results such as a good color matched skin, well-formed ear convolution, no other donor site scars can now be achieved using this new method.     

Firm elevation of the auricle in reconstruction of microtia with a retroauricular fascial flap wrapping an autogenous cartilage wedge.

During conventional reconstruction of the auricle in patients with microtia, simply separating the auricle from the mastoid region with a full-thickness skin graft usually fails to create firm elevation and sufficient projection. To achieve frontal symmetry is difficult, and sometimes the normal auricle needs to be set back. We reconstructed the auricle in patients with microtia in two major stages using a modified Nagata's method. Using a wide W-incision skin flap, the first stage includes implantation of a cartilage framework and transposition of the ear lobule. Our modification lies in the second stage. Instead of using the superficial temporoparietal fascial flap, we elevated a retroauricular fascial flap from the mastoid region, turning it over to wrap an autogenous costal-cartilage wedge, and covered it with a full-thickness skin graft. Between June 1996 and May 1999, eight patients underwent this operation. All the fascial flaps and overlying full-thickness skin grafts survived well. The advantages of our technique include firm elevation, good frontal projection and a natural appearance of the posterior aspect of the ear. Additionally, by using this fast and practical procedure, we avoid creating additional scars on the scalp and preserve the superficial temporoparietal fascia and superficial temporal vessels.     

烧伤后全耳缺损Ⅰ期再造术

目的 探讨颞浅筋膜瓣翻转覆盖Medpor耳支架Ⅰ期全耳再造术在烧伤后全耳缺损修复中的应用效果和操作要点。方法 以Medpor为耳廓支架，掀起颞浅筋膜瓣，翻转包裹Medpor耳支架，筋膜表面游离植皮行Ⅰ期全耳再造术，共修复15例烧伤后全耳廓缺损患者。结果 15例患者再造耳廓外形满意。结论 颞浅筋膜瓣翻转包裹Medpor支架Ⅰ期全耳再造，具有手术时间短，操作步骤少，患者损伤小以及术后耳廓形态满意等优点，是一种适合于修复烧伤后全耳廓缺损畸形的手术方法。