皮肤软组织扩张与自体肋软骨移植外耳再造术的护理对策

目的:总结皮肤软组织扩张与自体肋软骨移植法外耳再造相关护理的经验及效果。方法:2008年1月至2012年1月共收治耳廓缺损患者20例,其中先天性小耳畸形18例,外伤性耳廓缺损2例;手术方法:Ⅰ期耳后乳突区置入皮肤软组织扩张器,Ⅱ期利用扩张的耳后皮瓣及筋膜瓣覆盖自体肋软骨耳支架加皮片移植,形成再造耳,Ⅲ期行耳屏、耳甲腔等整形术。相应的护理对策措施主要有:围手术期的护理、心理护理、引流管的护理。结果:随访6个月~4年,均完成三期耳再造术,再造耳位置正常,形态良好,三维结构清晰,医患双方满意;未发生扩张器外露、感染、扩张器埋置术后血肿、软骨支架外露等并发症。结论:加强围手术期的护理和健康指导,可以减少并发症,是获得皮肤软组织扩张与自体肋软骨移植法外耳再造法手术成功的关键。     

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.     

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。     

不同方法治疗外伤性耳廓缺损

目的探讨根据耳廓缺损部位和耳后乳突区皮肤损伤程度的不同,选择不同的手术方式治疗外伤性耳廓缺损的可行性并评价手术效果。方法本组108例外伤性耳廓缺损患者,采用两种耳廓再造的方法,72例运用耳后皮肤软组织扩张术行耳廓再造,36例运用Brent技术行耳廓再造,耳支架均采用自体肋软骨雕刻。结果 108例再造外耳均愈合良好,外形满意,双侧耳对称。有4例出现耳软骨支架外露,经治疗后愈合。结论根据患者自身情况,制定个性化治疗方案,可以在提高手术安全性前提下,达到最佳的效果。     

自体肋软骨+medpor耳基复合耳廓支架一期全耳再造

目的　介绍一种制作简便 ,立体感强 ,不易吸收变形 ,柔韧性良好的复合耳廓支架。方法　采用外形细圆 ,有一定拱形弧度的自体第 9肋软骨制作外耳轮 ,以medpor做耳基形成复合耳廓支架 ,依照健侧耳廓模型塑形固定 ,覆盖颞浅筋膜及皮片 ,行一期全耳再造术。结果　临床应用 9例均效果满意 ,再造耳廓形态自然 ,立体感强 ,质感柔韧 ,术后随访 3个月～ 2年无一例支架外露或吸收变形。结论　自体肋软骨 medpor耳基复合耳廓支架综合了自体肋软骨及medpor耳支架二者优点 ,弥补了肋软骨耳支架易于吸收变形、雕刻塑形困难 ,而medpor外耳轮偏硬 ,容易出现支架外露等各自不足 ,具有实用性强、操作简单、创伤小和并发症少等优点 ,是目前全耳再造术中较为理想的耳廓支架。     

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。     

蝶形耳廓畸形的分型与手术修复

目的对具有耳廓中、下1/3发育不良和先天性招风耳、贝壳耳综合特征的蝶形耳廓畸形进行分型及手术修复。方法Ⅰ型蝶形耳廓利用软骨翻转折叠缝合法修复;Ⅱ型蝶形耳廓采用局部皮瓣转移法修复;Ⅲ型蝶形耳廓运用软组织扩张器结合自体肋软骨支架法修复。结果2001年10月至2005年3月,应用软骨翻转折叠缝合法修复Ⅰ型蝶形耳廓4例,完全纠正了耳颅角过大,重建了耳舟和对耳轮;利用局部皮瓣法修复Ⅱ型蝶形耳廓6例,术后耳廓较对侧略小,形态满意;采用软组织扩张器结合自体肋软骨支架法修复Ⅲ型蝶形耳廓9例,术后移植软骨、皮片成活良好,耳廓和对侧大小、形态一致。结论根据蝶形耳廓畸形的严重程度将其分为Ⅰ、Ⅱ、Ⅲ型,并分别运用软骨翻转折叠缝合法、局部皮瓣转移法、软组织扩张器结合自体肋软骨支架法修复,手术效果好,适于推广。     

双侧先天性小耳畸形的耳廓再造术

目的：探讨双侧先天性小耳畸形的外耳再造手术治疗方法。方法：2007年3月～2008年6月对21例双侧先天性小耳畸形采用耳后皮肤扩张结合自体肋软骨支架植入,耳后筋膜瓣掀起,中厚植皮术双侧同期进行外耳再造。结果：经6个月-1年的随访观察,21例中除2例再造耳有不同程度的软骨吸收、变形外,其余再造耳的大小、形状、位置与面部协调,双侧对称,再造耳外形逼真,微细结构显示清晰。结论：对于双侧先天性小耳畸形,同期应用耳后皮肤扩张结合自体肋软骨支架植入,耳后筋膜瓣掀起,中厚植皮术进行外耳再造,方案可行,效果满意,是双侧先天性小耳畸形理想的外耳再造手术治疗方法。     

耳甲腔型小耳畸形的耳廓再造术

目的 分析和探讨适合耳甲腔型小耳畸形的耳廓再造术.方法 采用自体肋软骨二期法耳廓再造术对13例(14只耳)耳甲腔型小耳畸形患者实施耳廓再造,一期为肋软骨耳廓支架的成型和移植,二期为颅耳角成形.结果 经过2个月至2年的随访,14只再造耳外形满意,耳解剖结构清晰,并拥有良好的颅耳角,其大小、位置与健侧耳也基本一致.结论 自体肋软骨二期法耳廓再造术是矫正耳甲腔型小耳畸形较理想的手术方法.

Abstract：

Objective To investigate the method of auricular reconstruction for concha-type microtia. Methods Two-staged auricular reconstruction was applied in 13 cases (14 ears) with conchatype microtia. The cartilage auricular framework was fabricated and implanted in the first stage, followed by ear elevation and cranio-auricle angle formation at the second stage. Results The patients were followed up for 2 months to 2 years with satisfactory aesthetic result. The reconstructed ears had a good appearance and position, and were symmetric to the healthy ears. Conclusions The two-staged auricular reconstruction with autologous cartilage framework is ideal for concha-type microtia.     

Repositioning of posterior auricular muscle combined with conventional otoplasty: a personal technique.

Prominent ears are the most common deformity of the external ear in children. Since 1881 various treatments have been described but the choice of procedure still remains at the surgeon's preference. A posterior auricular muscle malposition is frequently present in prominent ear deformity even though this muscle shows only a rudimentary function in man. This article presents a technique to reposition the posterior auricular muscle as an adjunct to conventional otoplasty. A quadrangular cartilage paddle, where the muscle inserts, is raised with the muscle as a chondro-muscular flap that can be advanced and reset more peripherally. Eighty consecutive patients, followed up for at least 12 months, have been reviewed. The posterior auricular muscle repositioning combined with a lozenge shaped conchectomy has been successfully performed in 103 ears. The cartilage paddle proved to be a strong support which facilitates the re-insertion of the muscle. Repositioning of posterior auricular muscle allows a more anatomical correction of both ear's projection and slope improving symmetry with the contralateral side.     

Chongchet's otoplasty: not only a method of anthelix reconstruction

The cause of prominent ear deformity may be anthelix deficiency or a high conchal wall [2]. Chongchet's otoplasty [3] is an old method described for correction of anthelix deficiency via anterior scoring. The aim of this study is to show the use of Chongchet's otoplasty in conchal wall reduction and the use of auricular cartilage tension lines in surgical correction of prominent ear deformity. In 24 prominent ear cases with different causes anterior scoring was performed along the auricular cartilage tension lines. Conchal reduction as well as antihelical reconstruction was easily achieved by folding the cartilage; excess conchal wall cartilage was excised laterally. Long-term results show pleasing contours without any recurrence. In conclusion, Chongchet's otoplasty which permits conchal wall reduction and anterior scoring according to auricular cartilage tension lines facilitates conchal and antihelical folding.     

Porous polyethylene for the reconstruction of severe Cosman cleft ear deformities

“Cosman ear,” “question mark ear,” or “auricular cleft between the fifth and six hillock” are synonyma for a congenital malformation between the helix and the lobule. While there is no definitive surgical method for correction of this deformity, there is agreement that only minor forms can be satisfyingly corrected with local skin flaps, whereas severe deformities need autologous cartilage or similar for reconstruction. The present publication describes a new method to correct a bilateral severe Cosman cleft ear deformity with a porous polyethylene framework and a postauricular fascia flap, leading to an appealing aesthetic result.     

耳廓无创矫正器在不同年龄段先天性耳廓畸形患儿中的应用效果

探讨耳廓无创矫正器在不同年龄段先天性耳廓畸形患儿中的应用效果。方法 选取 2022年1月-2023年1月我院收治的140例先天性耳廓畸形患儿为研究对象，依照患儿的年龄将其分成＜1月 龄组（n =60）和1~3月龄组（n =80）。两组均应用耳廓无创矫正器进行治疗，比较两组临床疗效、耳廓形 态、耳廓矫正器佩戴时间、并发症发生情况。结果 ＜1月龄组治疗总有效率为100.00%，高于1~3月龄组的 90.00%，差异有统计学意义（P＜0.05）；＜1月龄组治疗后患儿形态耳长、容貌耳长、形态耳宽、容貌耳宽 指标值高于1~3月龄组，且其颅耳间垂直距离指标值低于1~3月龄组，差异有统计学意义（P ＜0.05）；两组 治疗后颅耳角比较，差异无统计学意义（P ＞0.05）；＜1月龄组患儿佩戴时间低于1~3月龄组，差异有统计 学意义（P ＜0.05）；两组并发症发生率比较，差异无统计学意义（P ＞0.05）。结论 针对先天性耳廓畸形 患儿，无创矫正器具有较好的应用效果，患儿年龄越小，所需治疗时间越短，获取的治疗效果也越好。     

New Posterior Auricular Perichondrial Cutaneous Graft for Stable Reconstruction of Nasal Defects

The perichondrial cutaneous graft (PCCG), a reliable composite graft that provides stability, is routinely harvested from the anterior conchal bowl. This established PCCG was simplified by using the less conspicuous posterior auricular donor site, which can be closed without the need of cartilage resection for reconstruction with a postauricular interpolated skin island. Patients with basal cell carcinoma of the nose underwent reconstruction of the nose with a PCCG if parts of the tip cartilage or the fibrofatty tissue were resected. The defect surface area was assessed with a template. Follow-up evaluation included assessment of graft survival, donor-site morbidity, nostril stability, and aesthetic outcome. Of the 14 patients included in the study, whose average defect sizes were 2 cm² (ala) and 2.5 cm² (tip), 79% showed primary complete healing. Nostril stability was symmetrical 6 months postoperatively, and no contractions or depressed contour had occurred. In one case, a hyperpigmented area resulted in a slightly imperfect color match. All the donor sites healed without deformity or destabilization of the ear. With the use of this new posterior auricular donor site for graft harvest, functional, stable, and aesthetic reconstruction of the nose can be achieved. The graft- and donor-site morbidity rates are very low, and the results are fully satisfying.     

耳廓再造肋软骨切取术后胸廓外形改变的临床研究

目的 研究肋软骨切取术后胸廓外形的改变,为预防供区畸形提供理论依据.方法 选取1994至2003年在北京整形外科医院行耳廓再造的小耳畸形患者107例.通过对不同情况下胸廓的凹陷程度、肋弓缘的改变,分析影响胸廓外形变化的因素.使用Stata统计软件,用X2检验分析结果为阳性和阴性病例数间差异的统计学意义.结果 88例中,发生胸壁凹陷畸形48例(54.55%),其中轻度畸形35例(39.77%),重度畸形13例(14.77%);发生肋弓畸形46例(52.27%),其中轻度畸形33例(37.50%),重度畸形13例(14.77%).不同年龄段比较并发胸壁凹陷及肋弓畸形差异有统计学意义(P<0.01);不同随访时间并发胸壁凹陷及肋弓畸形比较差异无统计学意义(P=0.294.P=0.225);性别的差异在并发胸壁凹陷者中有统计学意义(P<0.01),但在并发肋弓畸形者中无统计学意义(P=0.619);切取第6、7肋软骨和第7、8肋软骨在并发胸壁凹陷者中差异无统计学意义(P=0.657),但在并发肋弓畸形者中差异有统计学意义(P<0.01).结论 早期手术(<13岁)胸部畸形的发生率明显增高;男性患者胸壁凹陷的表现率大于女性患者;切取第6、7肋软骨比切取第7、8肋软骨并发肋弓畸形的几率大;胸部畸形的发生率和随访时间的长短无关.     

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。     

Reconstruction of the microtic ear

Although microtia occurs in only 1:7000 to 8000 births, this major congenital ear deformity can result in significant psychological trauma for the affected child. Reconstruction of this complex deformity represents one of the greatest challenges to the reconstructive surgeon. Based on the pioneering work of Tanzer and Brent, the techniques have matured to the point that consistently good results can be obtained and many of the resultant problems associated with the deformity avoided. In classic microtia, a sausage-shaped vestige is made up of a rudimentary lobule and various additional remnants. The external canal is usually absent. Where hearing is normal in the opposite ear, it is not necessary to reconstruct the middle ear or external canal on the affected side, and these procedures may compromise the result of the external ear reconstruction. The staged reconstruction of the microtic ear, which can begin at 5 years of age, involves: placement of an autogenous cartilage framework; rotation of the lobule, formation of a conchal depression and tragal reconstruction; limited elevation of the helical rim; and minor final adjustments. The cartilage is placed during the first stage to make maximal use of the non-scarred elastic skin in the area of the skin pocket. This allows better splicing of the lobule in the second stage. The use of a very thin skin flap over the framework allows heightened definition of cartilage detail, better skin-cartilage coaptation, and at appears to play a vital role in preventing late deformation of the cartilage framework.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.