耳后皮肤扩张法治疗耳轮瘢痕疙瘩

目的 为治疗耳轮瘢痕疙瘩提供一种较好的外科治疗方法。方法 手术分两期：第一期，在耳廓背侧及耳后乳突区皮下置入容量为50ml的肾形扩张器，定期向扩张器内注水行耳后皮肤扩张；第二期，约2个月后切除耳轮瘢痕疙瘩，取出扩张器，将耳后扩张皮瓣向耳轮推进，覆盖创面。术后无需其它辅助治疗。结果 2000年以来，采用本术式共治疗12例16只耳的耳轮瘢痕疙瘩，随访3个月～2年，让实效果满意，无复发，修复后的耳轮外形良好。结论 本术式以血运丰富的耳后扩张皮瓣，无张力修复耳轮瘢痕疙瘩切除后的创面，对耳后乳突区为正常皮肤条件下的耳轮瘢痕疙瘩提供了一种较为理想的治疗方法。     

Anatomical features of auricular and retroauricular skin

Summary A comparative study is presented on the anatomy of auricular and retroauricular skin. Auricular skin is very thin and well furnished with vascular plexuses arranged parallel to the surface. The layer of subcutaneous fat is scanty, with no columnae adiposae extending into the dermis; the reticular layer of the dermis is evenly interspersed with adipose tissue. The organisation of adipose tissue is perivascular to the skin vessels. At the insertion of the auricle, the structure of retroauricular skin corresponds to that of auricular skin. Towards the hair line, the retroauricular skin gradually assumes the characteristics of the scalp. Consideration is given to the way in which the anatomy of the skin from the region of the ear influences the healing of such skin in free grafting.     

Nasal reconstruction using the Washio retroauricular temporal flap.

Reconstruction of an external nasal defect presents a challenge to the reconstructive surgeon. Transferring retroauricular tissue on a temporal pedicle was first described by Washio as a means to repair the central portion of the face. This paper describes our experience with the Washio retroauricular temporal flap for nasal reconstruction in twelve patients, together with our modifications to simplify the planning and raising of the flap. There was one patient with a stitch abscess, one case of hair loss from the pedicle which recovered within one month and one elderly patient who developed thromboembolic complications. There was no instance of flap necrosis. Our results confirm that the Washio retroauricular flap is an excellent technique for difficult nasal reconstruction in young patients.     

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.     

The combined posterior temporoparietal and galeal fascial flap: a new flap in the elevation of the constructed auricle (second stage of microtia correction).

Over the past few years, the technique of elevating the buried ear framework in the second stage of microtia correction has shifted from skin grafting to the use of flaps and cartilage blocks in the retroauricular sulcus. While the temporoparietal fascial flap should be reserved for secondary procedures and the treatment of complications, the mastoid fascial flap is inadequate by itself and needs an additional cartilage graft. Here, we describe a new flap, the combined posterior temporoparietal and galeal fascial flap, for the elevation of the buried ear cartilage. The flap is robust, with a dependable blood supply based on the posterior branches of the superficial temporal artery. In four cases the flap was rolled up and inset into the retroauricular sulcus, while in three cases an additional conchal cartilage graft was inserted into the roll. All the patients had satisfactory ear projection at follow-up 10-14 months postoperatively. We discuss the surgical technique and the advantages of this flap. We believe that this new flap, which has not been described before, has the potential to replace other flaps in the second stage of microtia correction.     

耳后游离皮瓣移植修复鼻部分缺损

目的 应用能携带耳廓软骨，色泽与鼻部相近的小型游离皮瓣修复鼻部分缺损。方法 采用以耳后动、静脉为血管蒂的耳后游离皮瓣行吻合血管的移植，对5例鼻部缺损进行了修复。结果 3例术后皮瓣血运完全正常，2例术后1－4d内有不同程度的静脉回流障碍。5例皮瓣最终全部成活，术后效果较为满意。结论 本手术供区隐藏，皮瓣不臃肿，色泽与鼻部相近，1次手术即可达到较满意的修复效果，是修复鼻尖、鼻翼大部缺损可供选择的一种方法。     

Anatomic description of the free retroauricular flap

Twenty-five human cadavers were examined to study the anatomy of the closed vascular system between the retroauricular artery and the retroauricular vein in the skin on the posterior aspect of the auricle and the mastoid process. The mean external diameters of the vessels supplying this region are 1.2 mm (artery) and 1.4 mm (vein). A flap averaging 5 x 7 cm may be taken from this area for use as facial cover.     

应用颞浅动脉跨区供血的反流轴型耳后岛状皮瓣修复面部缺损

目的:探讨颞浅动脉跨区供血的反流轴型耳后岛状皮瓣在修复面部缺损中的应用。方法:根据颞浅动脉的解剖分布及其与耳后动脉的吻合特点,制备以颞浅动脉供血的耳后岛状皮瓣,经皮下隧道转移至受区,修复面部缺损。结果:本组19例患者,17例全部存活,皮瓣的形态、色泽及功能良好。2例早期出现静脉回流障碍,积极处理后,皮瓣远端仅有小部分表皮坏死。结论:颞浅动脉跨区供血的反流轴型耳后岛状皮瓣修复面部缺损,是比较理想的修复方式。     

颞顶筋膜岛状瓣植入耳后乳突区预制扩张筋膜皮瓣修复面部皮肤软组织缺损

目的探讨一种较好的修复面部皮肤软组织缺损的手术方法。方法手术分两期进行。一期手术时,以颞浅动静脉为蒂,掀起颞顶浅筋膜岛状瓣,沿同侧发际线切开,在耳后乳突区皮下剥离,形成适当大小的囊腔,将颞顶筋膜瓣转移至囊腔内,适当固定,于筋膜瓣下放置皮肤扩张器;扩张完毕后,取出扩张器,以颞浅动静脉为蒂,掀起耳后乳突区预制岛状筋膜皮瓣,用于面部皮肤缺损的修复。结果自1999年以来,临床应用9例,其中面部黑痣2例,面部血管瘤2例,面部瘢痕5例。颞顶筋膜岛状皮瓣蒂长5.5~7cm,平均6.2cm,筋膜瓣面积4cm×3cm~7cm×7cm,平均5.7cm×4.9cm,预制筋膜皮瓣面积为5cm×5cm~8.0cm×7.5cm,平均6.4cm×6.1cm;术后皮瓣全部成活,供瓣区直接拉拢缝合者5例,另行皮片移植修复者4例。结论颞顶筋膜皮瓣血管蒂长,转移方便,血运丰富,耳后乳突区皮肤在质地、色泽、厚度等方面均与面部皮肤最为接近,是一种良好的修复面部皮肤软组织缺损的方法。     

An innervated retroauricular skin flap for total earlobule reconstruction.

In this article, the authors describe a technique for total earlobule reconstruction in a patient who underwent earlobule excision for basal cell carcinoma.The reconstruction was by means of an innervated retroauricular skin flap, folded double.The flap presented preserved skin sensitivity over all the reconstructed area, which is compromised by those techniques using a cranially or medially based flap which lead to the reconstruction of an insensible earlobule. This is a very important aspect of this technique, especially for those who wear pendant earrings, since a non-sensitive lobule would be more vulnerable to traumas causing laceration.In addition, it allows a good aesthetic result without evident donor site scars.Further investigation is needed to decide if this method is suitable for other types of total earlobule loss (e.g. congenital, traumatic), or not.     

Ohrrekonstruktion mit Medpor®-Gerüsten – Tipps und Tricks

In the case of traumatic defects or congenital malformations, ear reconstruction using a porous polyethylene framework covered by a temporal parietal fascia flap (TPFF) is one of the best known procedures. Due to the material’s porosity, blood vessel and tissue ingrowth into the grafts is possible. The complex form of the ear to be reconstructed is achieved within a relatively short time and with tolerable discomfort for the patient; this can even be achieved in one surgical session if tragus reconstruction is successful in the first session. During surgery, particular attention should be paid to preserving the course of the superficial temporal artery and veins, as well as their integration into the TPFF. The ear framework is tailored individually using the implant components“ear base” and“helical rim”, while the contralateral ear is used as the template for the ear to be reconstructed. The framework is covered by the TPFF, which is elevated by a combination of mastoid skin incision and endoscopy from the cranial end of the fascia flap. The TPFF is laid loosely, without any tension, over the entire framework and then covered with the available local skin, retroauricular full-thickness skin from the healthy side and groin skin. Skin quality should be taken into consideration in advance with regard to the expected outcome.     

One stage reconstruction of nasal defect by reverse flow retroauricular island flap - case series and discussion.

A reverse flow retroauricular island flap was successfully used for reconstruction of nasal defects as a one stage procedure in three cases. The length of the pedicle allows its transfer to cover defects of the nose. There was no partial or total flap necrosis and scars were inconspicuous. The patients were very satisfied with the result. Although this technique is of a higher level of difficulty than a conventional washio flap, it allows aesthetically favourable nasal reconstruction by a single stage operation in selected cases.     

耳畸形整形术

目的探讨和评价不同耳畸形的手术方法、效果及其影响因素.方法根据耳畸形的不同情况,利用自体肋软骨,对379例（401耳）采用双叶皮瓣法、29例（29耳）采用耳后沟皮瓣行耳廓再造及耳道成形术.对84例（84耳）气化型乳突患者同时行耳道成形术和鼓室成形术.结果335例（82%）术后随访3个月以上,其中273例（67%）随访0.5～5年,手术效果满意,再造耳形态逼真,颅耳角满意;358例（380耳）先天性小耳畸形术后复查听力,335耳术后听力有不同程度提高,其中84耳同时行耳道成形术和鼓室成形术,听力改善更明显;45耳术后听力无明显改善（＜10 dB）.结论自体肋软骨是耳再造的理想材料,双叶皮瓣及耳后沟皮瓣行耳再造效果满意,听力有所提高.     

耳屏周小切口在腮腺良性肿瘤切除中的应用

【摘要】目的评估耳屏周小切口在腮腺良性肿瘤切除术中应用的临床价值。方法30例腮腺良性肿瘤患者,应用耳屏周小切口行浅叶部分切除、保留面神经和耳大神经的腮腺良性肿瘤切除术。术后随访3～24个月,观察耳屏周小切口的美观度及临床疗效。结果所有患者均临床Ⅰ期愈合,术后腮腺功能良好,无涎瘘发生。随访,患者双侧外形对称,无凹陷等畸形,手术切口隐蔽,患者对耳周切口美学效果满意。本研究中出现术后暂时性面瘫患者2例,皮质激素并配合神经营养药物综合治疗后3个月均恢复正常;出现术后耳垂麻木不适患者4例,手术后3～10个月均逐渐恢复。本研究中所有患者均未出现味觉出汗综合征,无肿瘤复发。结论耳屏周小切口隐蔽、瘢痕小、并发症低,术后美容效果理想。     

颞顶筋膜瓣在修复外耳再造术后支架外露的应用

目的：探讨应用颞浅血管为蒂的颞顶筋膜瓣在外耳再造术后支架外露后进行修复的效果。方法：根据软骨支架外露形状,设计颞浅血管为蒂的颞顶筋膜瓣旋转包裹外露支架,加游离移植中厚皮、抗感染治疗。结果：8例患者术后再造耳支架外露修复效果良好,再造耳外形无明显改变。结论：外耳再造术后如发生再造耳皮瓣破溃、软骨支架外露的并发症,选择颞顶筋膜瓣旋转包裹外露支架,加游离移植中厚皮、抗感染治疗的治疗方法,可获得较满意的修复效果。     

Anterior approach to implant the Jarvik 2000 with retroauricular power supply

The retroauricular power supply of the Jarvik 2000 (Jarvik Heart Inc, New York, NY) left ventricular assist device is suitable for permanent support, as it is associated with fewer infections than conventional drivelines. Implantation through a left-lateral thoracotomy limits the performance of additional cardiac procedures. We describe a technique that used a sternotomy for the implantation of the Jarvik 2000 with retroauricular power supply in two patients. The retroauricular power supply of the Jarvik 2000 can be provided with an anterior approach, allowing full surgical access to the heart. If the outflow graft to the ascending aorta indeed reduces aortic stasis and thromboembolic events, the anterior approach with retroauricular power delivery might evolve into a standard procedure.     

耳后带蒂皮瓣下穿法修复耳廓前侧皮肤软组织缺损

目的:评价耳廓前侧皮肤软组织缺损采取耳后皮瓣下穿法修复治疗的临床效果。方法:对17例耳廓前侧肿物切除术后患者,采用耳后皮瓣修复耳廓前皮肤软组织缺损。结果:本组17者术后皮瓣存活好,无坏死,术后7天拆线术后平均随访6个月,肿物无复发,耳廓外观及皮肤色泽良好,患者满意。结论:耳后带蒂皮瓣下穿法转移能很好的修复耳廓前侧皮肤缺损,具有术后瘢痕小,色泽质地与周围皮肤接近,供区隐蔽的优点,取得满意效果,是治疗的选择方案之一     

Eye socket and eyelid reconstruction using the combined island frontal flap and retroauricular island flap: a preliminary report

One-stage eye socket and eyelid reconstruction was performed, with relatively satisfactory results, on a patient with a broad forehead. This was done after the complete exenteration of the orbit, using an island frontal flap and a retroauricular island flap with the common superficial temporal vessels. A Foley urethral catheter and a continuous suction drainage tube were effective for good wound healing between the bony orbit and a skin bag, made with a frontal flap, which was hidden in the orbital cavity. On the eighth postoperative day, the skin incision producing the false palpebral fissure was made, and it was enlarged slightly thereafter. A nylon implant was inserted into the orbital apex and cartilage grafts from the auricle to the false upper and lower eyelids were performed secondarily. The fundamental consideration of the eye socket and facial coverage corresponding to the eyelids and the possibility of modification of the author's method are briefly discussed.     

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.     

Auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap

A technique to take an auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap is described. Not only can this procedure remove the composite graft without auricular deformity, but it is also useful for covering small auricular defects after trauma or tumor excision.