再造耳廓生长情况的临床研究

目的：通过对再造耳廓生长情况的回顾和随访,为临床选择合适的手术年龄、合适大小的耳廓提供理论依据。方法：在整形外科医院9年间入院的患者中,选取应用皮瓣扩张、自体肋软骨支架移植方法行耳再造的、单侧、Ⅲ度、术后时间在2.5年以上的小耳畸形患者,共107例。调查内容包括：①患者的基本情况;②描出并使用微电子面积测量仪测出每组原正常耳廓、现再造耳廓及现正常耳廓样本的面积。并计算每组样本之间的面积比,对其面积变化幅度进行分析。使用St at a统计软件,用配对t检验方法来检验平均面积之间的差异的统计学意义。结果：有66例原始病例保存完整。年龄平均11.0岁（11.0±6.2岁）。随访时间：平均（3.0±0.7）年。66例患者中,与原正常耳廓相比,现再造耳廓平均增长4.4cm2;现正常耳廓平均增长2.01cm2。有89.4%的患者现再造耳廓的面积大于等于原正常耳廓面积。有81.8%的患者现正常耳廓的面积大于等于原正常耳廓面积。差异均有显著统计学意义。在小于13岁患者中,与原正常耳廓相比,现再造耳廓平均增长4.67cm2;现正常耳廓平均增长2.6cm2。88.9%现再造耳廓的面积大于等于原正常耳廓面积。80.0%现正常耳廓的面积大于等于原正常耳廓面积。差异有显著统计学意义。在大于13岁患者中,与原正常耳廓相比,现再造耳廓平均增长3.86cm2;现正常耳廓平均增长0.77cm2。90.5%现再造耳廓的面积大于等于原正常耳廓面积。85.7%现正常耳廓的面积大于等于原正常耳廓面积。原正常耳廓和现正常耳廓平均面积之间的差异无显著统计学意义;而原正常耳廓与现再造耳廓平均面积之间的差异有显著的统计学意义。结论：现再造耳廓平均面积生长快于现正常耳廓。再造耳廓和正常耳廓的生长都主要是在早期年龄段。再造耳廓生长速度可能超过正常耳廓的生长速度。     

自体肋软骨联合EH骨水泥支架两期耳再造的临床应用

目的:探讨自体肋软骨联合EH骨水泥支架两期耳再造法再造全耳的效果。方法:手术分两期:I期手术:耳垂的转位,残耳软骨的剔除,耳支架的雕刻及植入;II期手术:I期6月～1年后进行,颅耳角的重建,EH骨水泥支架的植入及耳后创面植皮。结果:临床应用38例(42耳),随访6月～2年,42只再造耳轮廓清晰、外形满意。其中有2耳的耳支架软骨在耳垂交界处出现软骨外露,经局部皮瓣的转移后成功覆盖,3例术后耳后皮片挛缩出现耳颅角变小,双侧不对称。其余均未发现明显的软骨吸收或颅耳角的缩小,耳廓皮肤色泽接近正常,与健侧耳基本对称。结论:自体肋软骨联合EH骨水泥支架两期耳再造法,手术次数少,患者住院花费少,手术方法简单易操作,术后耳廓外形满意,术后并发症少,值得在临床推广。     

健康年轻女性耳垂测定及相关因素分析

目的:探讨健康年轻女性不同身高、体重对耳垂形态的影响,为耳垂整形手术提供参考资料。方法:2016年3—7月,郑州大学第一附属医院整形外科测量266名健康年轻女性的身高、体重、耳宽形态、耳长形态、耳宽貌、耳长貌、耳垂宽、耳垂长等项目,计算各测量值 ± s,对有关各项指标用SPSS 15.0统计软件...     

Thermosensitivity in a reconstructed microtic ear

The aim of this study was to evaluate thermo-thresholds in autologous reconstructed microtic ears. Nineteen patients with unilateral microtia were investigated no less than two years after the last operation (3.6+/-1.7 years). Their normal corresponding ear acted as controls. Eight healthy children were also investigated to illustrate technical differences between measuring the two sides. Thermal sensitivity was tested quantitatively using a SENSELab MSA Thermotest. The skin temperature was also tested. Three different areas of the ear were examined: the lobe, the antihelix, and the helix. The reconstructed ear had a significantly higher skin temperature for all investigated areas compared with the normal ear (reconstructed ear 30.2+/-1.2 degrees C, normal ear 28.6+/-0.9 degrees C). For the controls there were no significant differences in any area. For the patients there were small differences in perception of cold between the reconstructed and the normal ear. There were significant differences in the antihelix region and the helix in heat perception in the reconstructed ear compared with the normal one (helix reconstructed ear 43.9+/-3.8 degrees C, helix normal ear 38.3+/-3.0 degrees C, antihelix reconstructed ear 39.9+/-3.0 degrees C, antihelix normal ear 36.4+/-1.7 degrees C). The reconstructed ear had a changed thermosensitivity, but there did not seem to be any clinical disadvantages.     

Thermosensitivity in a reconstructed microtic ear

The aim of this study was to evaluate thermo-thresholds in autologous reconstructed microtic ears. Nineteen patients with unilateral microtia were investigated no less than two years after the last operation (3.6±1.7 years). Their normal corresponding ear acted as controls. Eight healthy children were also investigated to illustrate technical differences between measuring the two sides. Thermal sensitivity was tested quantitatively using a SENSELab MSA Thermotest. The skin temperature was also tested. Three different areas of the ear were examined: the lobe, the antihelix, and the helix. The reconstructed ear had a significantly higher skin temperature for all investigated areas compared with the normal ear (reconstructed ear 30.2±1.2°C, normal ear 28.6±0.9°C). For the controls there were no significant differences in any area. For the patients there were small differences in perception of cold between the reconstructed and the normal ear. There were significant differences in the antihelix region and the helix in heat perception in the reconstructed ear compared with the normal one (helix reconstructed ear 43.9±3.8°C, helix normal ear 38.3±3.0°C, antihelix reconstructed ear 39.9±3.0°C, antihelix normal ear 36.4±1.7°C). The reconstructed ear had a changed thermosensitivity, but there did not seem to be any clinical disadvantages.     

残耳组织在小耳畸形外耳再造中的应用

目的 总结外耳再造术中对残耳进行的不同处理,探讨合理应用残耳的方法. 方法 2005年9月-2006年7月,对128例单侧小耳畸形患者采用分期手术进行矫治.男79例,女49例;年龄5～21岁,平均11岁.左耳44例,右耳84例.残耳呈花生状56例,腊肠状35例,舟状27例,贝壳状10例.外耳道正常存在5例,狭窄11例,闭锁112例.患耳按耳廓发育情况分为Ⅰ度17例,Ⅱ度98例,Ⅲ度13例.一期手术时植入50 mL肾形扩张器1枚.对于残耳上端距发际线较近者,同期将残耳中上部纵行切开,去除多余的残耳软骨,切口直接缝合.二期手术时利用残耳中上部覆盖软骨支架下部,根据残耳的具体位置,应用"V-Y"推进、"Z"成形术和残耳向上逆转等方法矫正残耳位置.三期手术时利用保留的残耳再造耳轮脚或覆盖再造耳修整时形成的创面. 结果 患者残耳经改形或移位后血运良好,全部成活.切口Ⅰ期愈合.患者均获8～15个月随访.以残耳形成的耳垂外形丰满自然,再造耳与健侧耳基本对称.再造耳耳垂存活良好,无破溃.再造的耳轮脚清晰可见,耳轮、对耳轮及三角窝结构清晰,患者及家属均满意. 结论 合理应用残耳是成功施行外耳再造术、保证再造耳与健侧耳对称的重要环节.     

Two flaps and Z-plasty technique for correction of longitudinal ear lobe cleft.

Various surgical techniques have been reported for the correction of congenital ear lobe deformities. Our method, the two-flaps-and-Z-plasty technique, for correcting the longitudinal ear lobe cleft is presented. This technique is simple and easy to perform. It enables us to keep the bulkiness of the ear lobe with minimal tissue sacrifice, and to make a shorter operation scar. The small Z-plasty at the free ear lobe margin avoids notching deformity and makes the shape of the ear lobe smoother. The result is satisfactory in terms of matching the contralateral normal ear lobe in shape and symmetry.     

自体肋软骨在小耳再造中的应用体会

目的：探讨自体肋软骨在小耳再造中的应用体会.方法：采用自体肋软骨分期修复的方法治疗14例先天性小耳畸形.结果：14例患者对耳畸形修复后的耳廓外形感觉满意.结论：自体肋软骨由于取材于自身组织,无排斥反应、感染率低,易于塑形,术后效果良好.     

中耳弥漫性炎性感染伴胆脂瘤行岩骨次全切除术的经验分析

目的 介绍中耳弥漫性炎性感染伴胆脂瘤行岩骨次全切除术中用带蒂颞肌瓣充填中耳乳突腔但不封闭外耳道的方法及观察术后效果。方法 对6例成人单侧中耳弥漫性炎性感染伴胆脂瘤患者行岩骨次全切除术,行耳甲腔成形,用带蒂颞肌瓣充填中耳乳突腔,同时封闭咽鼓管,但未封闭外耳道,观察术后并发症,干耳时间。结果 术后随访1年以上,所有6例患者术后均无脑脊液耳漏,无脑膜炎等颅内感染,4例患者术后3个月干耳,2例患者术后6个月干耳,其中1例患者在术后1年出现胆脂瘤局部复发,但无耳流脓,予定期耳内镜下清理。结论 岩骨次全切除术是治疗中耳弥漫性炎性感染伴胆脂瘤的有效方法,用带蒂颞肌瓣充填中耳乳突腔,封闭咽鼓管,可有效地防止相关并发症发生及中耳乳突再发感染,不封闭外耳道口有利于术后随访清理。     

Preauricular flap for post burn ear lobe reconstruction - a case report

Burns of the face often affect the ear causing deformation of the pinna or ear lobe due to perichondritis or loss of cartilage and excess scarring. The reconstruction of the ear lobe may be limited due to scarring of the surrounding tissues. We describe a preauricular flap for reconstruction of the anterior and posterior surface of the ear lobe following burn injury. This two stage technique of ear lobe reconstruction by a preauricular flap is not described in the available literature. An inferiorly based preauricular flap was harvested in a young lady who had post burn loss of the right ear lobe. This was folded on itself and sutured to reconstruct both surfaces of the ear lobe. After 6 months, it was released from its attachment at the retromandibular area to define the cheek lobe angle and to shape it. The preauricular flap for ear lobe contouring is a simple and easy technique. An adequate length may be harvested without significant donor site morbidity.     

快速成形技术在全耳再造术中的临床应用

目的探讨快速成形技术在全耳再造术中的临床应用。方法螺旋CT扫描获取患者健侧外耳影像数据,经Mimics软件转换成STL格式文件,建模后通过镜像技术应用于快速成形系统,构建患侧外耳三维模型,在二期法全耳再造中用于术中指导一期患侧小耳的自体肋软骨耳支架的雕刻及二期颅耳角的个性化重建。结果自2012年至今采用快速成形技术构建患侧小耳模型9例,重建外耳亚结构单位大于10个,颅耳角成形稳定。随访6~13个月,患者及家属满意。结论应用快速成形技术构建外耳三维模型,相对于传统二维胶片模型更为直观、立体,值得临床应用。     

Ischemic rabbit ear model created by minimally invasive surgery

A rabbit ear ischemic model was created using a minimally invasive surgical technique. On one ear, three small skin incisions were made on the vascular pedicles about 1 cm from the base of the ear. The central and cranial arteries were ligated and divided along with their accompanying nerves. A circumferential subcutaneous tunnel was made through the incisions to cut subcutaneous tissues, muscles, nerves, and small vessels. The other ear was used as a normal control. Wounds were made on the ventral side of the ear. Twenty-two rabbits (14 young adults, four aged, and four diabetic) were used. In the 26 pairs of wounds in young adult rabbits, the mean healing time on the ischemic ear was 20.5+/-3.4 days vs. 14.9+/-1.6 days on the normal ear (mean+/-SD) when normal saline was used as a dressing. Tissue high-energy phosphate contents were higher in the normal ear than in the ischemic ear. The skin temperature on the ischemic ear was 1-7 degrees C lower than that on the normal ear. Wound-healing times were longer in the aged and diabetic rabbits, but no complications occurred in these rabbits. The model created by minimally invasive procedure results in little skin disruption, a longer ischemic time, and a higher success rate as compared with many other models. It can be used in normal animals as well as aged animals, and for the first time, was used successfully in diabetic animals.     

EAR LOBE RECONSTRUCTION WITH A POSTERIOR EAR FLAP: Case reports

We describe a technique for reconstruction of the ear lobe. Although there are many procedures that aim to reconstruct the ear lobe naturally, the aesthetic results of using a posterior ear flap are better because the scar tissue that remains behind the ear is invisible.     

A new method in the treatment of ear amputation: experimental and clinical study

There have been plenty of reconstruction methods for ear amputation, and replantation preserves its importance. In situations where replantation is not feasible, various methods were proposed. We indicate an alternative technique for the ear amputation without replantation indication. The method of replacing of a vascular structure into the tunnel formed on the posterior side of the amputated ear was used instead of replacing the ear cartilage into a vascular area that was described in the literature of ear prefabrication. The dorsal fascial flaps which were prepared from the back of 10 New Zealand rabbits were placed into the amputated ear. The 2 groups, control and the experimental, were consequently the ear that was adapted as a composite graft and the ear with the flap inserted. The ears were examined macroscopically and photographed on postoperative days 3, 7, 14, and 21. On the 21st day, the nourishment pattern of the ear, the dorsal fascia, and the dorsal fascia adapted ear were investigated with digital subtraction angiography (DSA). The group that received applied dorsal fascia possessed increased vascularity.The viability was evaluated with the biopsies taken from the control group and the group that received applied dorsal fascial flap on the 21st day. The cartilage and the connective tissue were viable in the flap-applied group, whereas there was necrosis in the control group. The reflection of the experimental study was performed on 2 subtotal and 1 total ear amputation cases, with the utilization of the superficial temporal artery. The nourishment of the flaps was evaluated with postoperative photographs, angiography, and bone scintigraphy.     

Ear lobe reconstruction with a posterior ear flap. Case reports.

We describe a technique for reconstruction of the ear lobe. Although there are many procedures that aim to reconstruct the ear lobe naturally, the aesthetic results of using a posterior ear flap are better because the scar tissue that remains behind the ear is invisible.     

Pressure changes in the middle ear during nitrous oxide anesthesia

We studied middle ear pressure variations in 17 patients with mild upper airways or middle ear diseases, during nitrous oxide anaesthesia. We observed a significant increase in middle ear pressure during the administration of nitrous oxide, and a significant decrease after nitrous oxide was discontinued. Nine patients showed periodical reductions of the middle ear pressure during the inhalation of nitrous oxide, due to passive openings of the eustachian tube. In the remaining 8 patients (47%) this mechanism has not been effective. A comparison between these two groups shows significantly higher levels of middle ear pressure in the group of patients with abnormal function of the eustachian tube, both during and after the administration of nitrous oxide. Our results demonstrate that patients with mild upper airways or middle ear diseases are likely to show an impaired tubal function. Therefore, nitrous oxide should be used with caution in the presence of such diseases. Moreover, nitrous oxide is generally controindicated in middle ear surgery, as the pressure gradients between middle and external ear can jeopardize the success of the operation.     

Team approach to total auricular reconstruction

The surgery of microtia is a procedure that demands surgical and artistic skills, as well as precise planning of interventions. In cases where a functioning inner ear is present, functional and esthetic reconstruction is performed jointly with ear, nose, and throat surgeons. The middle ear plasty is performed through a transmastoidial approach at the time of the second stage of the outer ear reconstruction. We demonstrate the special requirements of this team approach and also pay a tribute to Burt Brent, who has set the standards of modern ear reconstruction.     

再造耳和对侧先天性招风耳同期修复术

目的:总结一侧再造耳和对侧先天性招风耳同期修复的经验。方法:对121例一侧为再造耳和另一侧为先天性招风耳的患者同期实施修复手术。参考再造耳的高度、颅耳角和对耳轮的形状、采用术者的方法矫正先天性招风耳,同时将去除的多余的皮肤游离移植,修复再造耳的耳甲腔或耳后瘢痕。结果:121例患者中,两耳对称,高度及耳颅角相似。再造耳耳甲腔皮片与周围皮肤匹配良好。招风耳术后对耳轮及上脚轮廓清晰,耳甲和耳舟成角正常。无并发症出现。效果满意。结论:对于一侧为再造耳另一侧为招风耳的患者,可同期手术,不但合理利用了皮肤,而且减少了手术及住院的次数,节约了时间和金钱,同时取得了良好的效果。     

利用耳廓复合组织片移植治疗环缩耳畸形

目的　用简单有效的方法治疗先天性单侧环缩耳畸形。方法　利用正常侧耳廓复合组织片移植于对侧畸形的环缩耳 (Ⅱ型 12例 ,Ⅰ型 3例 ) ,以此延长耳轮、显露耳舟及三角窝 ,从而矫正畸形。结果　 15例患者的耳廓复合组织片全部成活 ,耳轮延长 ,耳舟显露 ,从而使双耳基本对称。结论　本手术矫正环缩耳简单易行 ,效果满意。     

软骨膜下行软骨缝合法治疗招风耳

目的 探讨修复招风耳的一种手术治疗方法。方法 先设计常规定点，切开耳后皮肤、皮下组织，剥离耳软骨膜并推向两侧，在软骨上做纵行平行切口，不切透耳软骨。在软骨膜下于对耳轮嵴部行耳软骨水平褥式缝合，对耳软骨进行适当的调整，使耳软骨按设计点向后卷曲，形成外形自然的对耳轮。结果 本组患者10例，均获得外形良好，自然逼真的耳郭形态，随访6～12个月，无一例复发。结论在软骨膜下行软骨塑形，不破坏软骨的连续性，不会形成软骨下血肿，术后耳郭外形自然。是一种易于掌握，疗效确切，复发率低的较好方法。