颞浅筋膜蒂耳后扩张皮瓣全耳再造术

目的　探索使再造耳轮廓清晰、耳轮缘无毛发生长 ,又可同期处理残耳的全耳再造方法。方法　应用经皮肤扩张的颞蒂耳后筋膜皮瓣 ,向前上方旋转包裹整个耳支架进行全耳再造。结果　 1999年 2月至 2 0 0 0年 10月共完成全耳再造 18例 ,术后随访期平均 9个月 ,均取得满意效果。结论　颞蒂耳后筋膜皮瓣厚薄适中 ,无发区皮肤面积较大 ,应用该皮瓣再造的耳廓肤色均匀一致 ,耳轮缘无毛发 ,外耳轮及耳甲腔等细微结构清晰 ,颅耳角保持较稳定 ,其不失为一种较为理想的全耳再造方法 ,尤其适用于发际较低者及耳上部组织残缺较多者的全耳再造     

扩张法全耳再造皮瓣破溃后的处理

目的 探讨临床应用扩张法全耳再造过程中出现耳后扩张皮瓣破溃,采用Brent Ⅰ期耳再造术作为补救方法的可行性.方法 8例扩张法全耳再造术的患者,在扩张器注水过程中发生耳后扩张皮瓣破溃,将扩张器取出,植入自体肋软骨支架,行Brent Ⅰ期耳再造术.结果 8例创口均一期愈合,扩张皮瓣血供良好,再造耳形态逼真,轮廓清晰,耳轮毛发少,其大小、形状、位置与面部协调,效果满意.结论 Brent Ⅰ期耳再造术是扩张法全耳再造过程中发生耳后扩张皮瓣破溃后的一种较好补救方法.     

耳后扩张皮瓣联合自体肋软骨移植修复耳轮部分缺损

目的：探讨耳后扩张皮瓣联合自体肋软骨支架在修复耳轮部分缺损的应用。方法：对7例耳轮部分缺损的患者使用耳后扩张皮瓣联合自体肋软骨支架移植进行修复。结果：本组患者7例,男5例,女2例,均采用上述方法治疗,经过6个月～2年的随访,皮瓣全部成活,再造耳轮轮廓清晰,无卷曲变形,无支架外露。再造耳与健侧基本对称。结论：耳后扩张皮瓣联合自体软骨移植是修复耳轮部分缺损的一种简单有效的办法。     

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.     

Combined Fascial Flap and Expanded Skin Flap for Enveloping Medpor Framework in Microtia Reconstruction

The Medpor implant is another choice for a new auricular framework besides autogenous costal cartilage. However, its relatively frequent exposure and less-matching skin coverage discourage surgeons from using it. In this article, we present a new two-flap method, a combination of the temporoparietal fascial flap and the expanded skin flap, for wrapping the Medpor implant in microtia reconstruction. A staged surgical procedure was performed, including soft tissue expansion in the mastoid region, soft tissue expander removal, expanded skin flap and temporoparietal fascial flap formation, Medpor framework implantation, and the combined two-flap envelopment. Conventional lobule transposition and tragus reconstruction were accomplished for selected patients. In this study, a total of 22 microtias were reconstructed consecutively using this method. Eighteen patients were followed since the first surgery. The postoperative follow-up time ranged from 3 to 12 months. The draped soft tissue covering was thin enough to show the reconstructed ear with excellent, subtle contour when edema gradually vanished 3-6 months postoperatively. The new ear had a stable shape, and its skin color and texture matched the normal surrounding skin very well. No exposure or extrusion of the framework was observed in the series. The Medpor implant enveloped by both a temporoparietal fascial flap and an expanded cutaneous flap appears to be a promising alternative for the auricular framework in microtia reconstruction. Because of the wrapping tissues, auricular construction using a Medpor implant can be a safe, steady, and easily acceptable choice for both microtia patients and their physicians.     

Ear reconstruction with a flap from the medial surface of the auricle

Correction of defects of the external ear following trauma or partial amputation for cancerous lesions is difficult. A flap from the medial surface of the auricle has been devised to correct the deformity. The flap is either introduced through the cartilaginous framework or passed around the edge of the helical cartilage for reconstruction of the lateral surface of the ear. The small part of the flap that passed underneath the auricular skin or through the auricular cartilage is deepithelialized. Six patients have been treated with this technique; they have had at least one year of follow-up and good postoperative results.     

One-stage reconstruction of an acquired major ear defect using an auricular cartilage sling and temporal fascial flap

To reconstruct a major middle third auricular defect, a two-stage operation is usual, using a skin flap with cartilage support. In this paper, a one-stage operation for an acquired ear defect using an auricular cartilage sling and temporal fascial flap with skin grafting is reported. The auricular cartilage graft was harvested along the antihelix and used for the reconstruction of the helical rim. This is a simple, easy, and safe method of one-stage reconstruction for an acquired ear defect in properly selected patients.     

The periosteal-cutaneous chimeric medial femoral condyle free flap for subtotal ear reconstruction: A case report

When costal graft is contraindicated or refused by the patient, autologous total/subtotal auricular reconstruction represent a real challenge as limited surgical options has been described. Aim of present report is to offer a novel possible autologous reconstruction of the ear frame using a chimeric free medial femoral condyle (MFC) flap. We present a case of a 29 years old patient who had total loss of the upper 2/3 of the right ear after bombing in Somalia and secondary infected condritis (considered a relative contraindication for costal cartilage graft). The MFC flap was harvested with a chimeric skin paddle (7 × 5 cm), a thin sheet of femoral cortex (6.5 × 8 cm) was used as basal ear frame, while part of the contralateral concha was trimmed as support for the helix, with the periosteal component of the flap wrapping around the whole framework. The chimeric skin paddle assured the retroauricular skin coverage, while the anterior part of the construct was covered by a thinned dermal flap. Postoperative course was uneventful. A defatting procedure of the posterior skin paddle was performed at 2 months post-op. At 6 months post-op, the patient was satisfied with the result, could wear glasses and was socially integrated. This new application of the free chimeric MFC flap, despite being not the primary choice for ear reconstruction, guaranteed satisfactory results in terms of ear shape and infection prevention and may be considered when ordinary cartilage rib reconstruction is refused, contraindicated, or failed.     

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。     

皮下蒂皮瓣与旋转皮瓣在颞部皮肤缺损修复中的联合应用

目的：探讨利用耳前邻近皮瓣与颞区邻近皮瓣联合应用修复颞部皮肤缺损的方法。方法：根据患者颞部皮肤肿物的大小,设计患侧耳前方皮下蒂皮瓣的切取范围并将切口线设计在耳前皱襞上。在颞部肿物外缘向耳上方延长切口线约为皮肤肿物直径的4倍,设计旋转皮瓣。2个皮瓣联合应用,修复颞部较大面积皮肤缺损。供区直接缝合。结果：共施行此类手术12例,患侧皮肤缺损修复满意,切口线相对隐蔽,面部器官形态功能均未受到影响,供区头发自然生长,瘢痕不明显。结论：利用皮下蒂皮瓣与旋转皮瓣联合修复颞部较大面积皮肤缺损,辅助切口少且切口隐蔽,同时皮瓣转移后自然平滑过渡,创面修复满意,无需植皮,瘢痕不明显。     

A new posteriorly based chondrocutaneous flap for the repair of middle third marginal auricular defects

 A new chrondrocutaneous flap raised from the posterior area was used to reconstruct composite marginal ear defects of two patients. In this technique, a posterior rectangular advancement flap with a cartilage strip was advanced into the defectly horizontal. Two weeks later, the pedicle was divided and the flap was tailored. The donor area was covered with a skin graft. This flap provides both ideal skin cover and support for the cartilaginous framework. It can be transferred without delay and can be used in immediate or secondary reconstructions. It is recommended as an alternative method for the reconstruction of the middle third marginal auricular defects. Received: 14 July 1996 / Accepted: 24 March 1997     

耳后延迟皮瓣自体肋软骨支架法外耳再造术

目的 探讨耳后延迟皮瓣自体肋软骨支架法外耳再造术的临床效果.方法 手术分3期进行：Ⅰ期为耳后皮瓣延迟术,术后3周左右进行Ⅱ期手术;Ⅱ期为自体肋软骨支架再造、延迟皮瓣覆盖及自体中厚皮片移植外耳再造术,术后半年据情进行Ⅲ期手术;Ⅲ期行耳屏再造、耳甲腔加深和再造耳局部修整术等.结果 对先天性小耳畸形28例,31只耳,分次完成Ⅰ～Ⅲ期手术23只耳,余8只耳只完成Ⅰ、Ⅱ期手术.术后外耳位置、大小及形态良好,并发症少,患者及家属基本满意.结论 应用皮瓣延迟术不但可获取足够面积富有血运保障的菲薄皮瓣,而且方法简单、安全,所需时间短.耳后延迟皮瓣自体肋软骨支架法外耳再造术,是一种良好的外耳再造术方法.     

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.     

Reconstruction of a near total ear amputation with a neurosensorial radial forearm free flap prelaminated with porous polyethylene implant and delay procedure

When an auricular defect is caused by high‐energy trauma that causes damage to the surrounding tissues, the patient may be not a candidate for reconstruction with local flaps and free tissue transfer may be necessary. Here we present a case of total auricular reconstruction in a 27 year‐old man who had total loss of the left ear and traumatized temporal skin and fascia. A radial forearm flap prelaminated by a porous polyethylene implant was employed. A “printed” ear made of silicone, based on the patient's CT ‐ scan of the contralateral ear, was used for intraoperative molding of the future reconstruction. Prolonged prelamination time and surgical delay (three months) were performed to reduce edema, distortion and loss of definition of the framework after revascularization. After subsequent integration and neovascularization of the added tissue, the prelaminated flap was transferred. Flap reinnervation was also performed by direct coaption of the great auricular nerve to the lateral antebrachial cutaneous nerve. The flap fully survived and there were no complications in the early postoperative period. Between 3 and 6 months, the patient returned to normal ranges in terms of warmth and cold, and recovered the discriminative facial sensibility. After one year the auricular reconstruction was intact and satisfactory aesthetic results were achieved. This method may offer a satisfactory solution for a difficult problem and may be considered for acquired total ear defects.     

Burned ear reconstruction using a prefabricated free radial forearm flap

Postauricular skin, postauricular fascia, temporoparietal fascia (pedicle or free), the free radial forearm flap (fascial or fasciocutaneous), and free lateral arm fascial flap, have been used for burned ear reconstruction reported in the literature. Patients who did not have normal tissue around the ear region, because of severe thermal injuries to the external ear, are not available for draping the costal cartilage framework; these patients require free flaps. The author reports a burned ear reconstruction, using a prefabricated free radial forearm fasciocutaneous flap, included an autogenous costal cartilage framework. In this case, the front and back of the cartilage framework were covered with the skin of the forearm flap. This is the main difference from other techniques in the literature. This flap is valuable for burned ear reconstruction, when local tissue and other free flaps are not available.     

耳后皮肤扩张术联合支架植入修复外伤性部分耳郭缺损

目的:介绍应用耳后皮肤扩张术联合支架植入修复外伤性部分耳郭缺损的方法.方法:手术分2期进行,Ⅰ期在耳后埋置扩张器并进行扩张;Ⅱ期手术以自体肋软骨或Medpor材料为支架,雕刻合适大小的支架,植入后与患侧耳残余软骨缝合,用耳后筋膜瓣和扩张皮肤覆盖支架,耳后区植皮.结果:临床应用1 96例患者,1 87例耳创面愈合良好,外形满意,双侧耳对称.仅有9例出现支架外露,经治疗后愈合.结论:应用耳后皮肤扩张术联合支架植入修复外伤性部分耳郭缺损,适合于绝大多数外伤性部分耳郭缺损的患者,效果良好、可靠,并发症低.     

Further application of the bilobed flap: the split bilobed flap for reconstruction of composite posterior auricular and mastoid defects.

In this article a modified bilobed flap from mastoid and lateral neck skin for reconstruction of complex defects of the posteromedial surface of the auricle and mastoid skin, with the preservation of the retroauricular sulcus, is described. Reconstruction of the postero-medial auricular surface has almost never been a concern for reconstructive surgeons. It is in fact a shaded area with little aesthetic relevance and direct closure, skin grafting and even secondary healing are used for skin cancer defects repair. Also mastoid skin defects can be repaired with simple techniques such as skin grafts or transposition flaps from the remaining mastoid skin or from the neck. On the other hand, cancers involving the postero-medial auricular surface, the retroauricular sulcus and the mastoid skin require wide and deep resections that involve the posterior auricular muscles and reach the perichondral and periosteal surfaces. Direct closure with undermining, if feasible, will obliterate the retroauricular sulcus causing asymmetry with the contralateral ear and, if defects are cephalad will impair the possibility of wearing spectacles, thus leaving functional and aesthetic impairment. Transposition flaps from the remaining mastoid skin, due to the lack of skin laxity, are not feasible because the donor site cannot be closed. Two patients, both affected by basal cell carcinoma involving the posteromedial auricular surface and the mastoid skin have been treated with this flap. In both cases the use of the modified bilobed flap described in this article allowed preservation of the retroauricular sulcus and closure of the donor site. Scars were hidden along minimal tension lines and the possibility of wearing spectacles along with sensitivity all over the reconstructed area were maintained.     

One-stage total reconstruction of the ear with simultaneous tympanoplasty

The one-stage total ear reconstruction (auricular reconstruction and tympanoplasty) has a number of merits. 1. Satisfactory esthetic results obtained in one operation. 2. The "super thin" skin flap is elevated on a plane that excludes hair follicles from the flap, so the hair-bearing areas of the scalp can be readily incorporated as part of the ear reconstruction. 3. The reconstructed ear has adequate blood supply and protective sensation. 4. The surgeon may choose to carry out a tympanoplasty and obtain restoration of auditory function or may choose to carry out a pseudomeatus procedure and reduce the operating time. We feel that the "super thin" skin flap and the simultaneous tympanoplasty are valuable supplements to ear reconstruction. The functional results of the tympanoplasty must be considered only a partial success at this time; long-term evaluation as well as technologic improvements are needed.     

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。     

颞筋膜蒂乳突发际皮瓣修复前额发际皮肤缺损

目的 探讨额颞部发际内外皮肤缺损的修复方法.方法 近十年间,应用耳后发际颞筋膜蒂岛状皮瓣转移修复前额颞部发际皮肤缺损5例.结果 皮瓣全部成活,5～7 d可见头发生长,发际内外界限清楚,额颞部形态佳.结论 应用耳后发际颞筋膜蒂岛状皮瓣转移修复颞额部发际皮肤缺损是一种可行的方法.