成人小耳畸形的“三瓣法”扩张器耳廓再造术

目的探讨成人小耳畸形的扩张器法耳廓再造术的序贯治疗。方法第一期手术行皮肤定量扩张器埋置;第二期扩张皮肤形成耳前扩张皮瓣(A瓣)、耳下扩张皮瓣(B瓣),同时残耳形成残耳皮瓣(C瓣),应用第七、第八或仅第七肋软骨雕刻立体支架进行耳廓再造术,A,B和C"三瓣"从前方、下后方和下方包裹支架,使用耳后筋膜瓣从后方包裹支架,筋膜瓣后方行皮片移植治疗。结果 2010年1月至2012年6月,共应用成人"三瓣"技术实施扩张器法耳廓再造73例(78耳)。再造耳廓立体感强、表面结构清晰可见,耳后瘢痕隐藏于颅耳沟中部。结论成人"三瓣法"小耳畸形的扩张器耳廓再造术并发症较少,再造耳廓不仅形态逼真而且耳后瘢痕隐蔽,值得推广应用。     

全扩张“单瓣法”外耳再造在耳廓畸形患者中的应用

目的 探讨全扩张“单瓣法”外耳再造在耳廓畸形患者中的应用及效果。方法 总结2019年1月—2022年9月武警部队山东省总队医院155例（162耳）耳廓畸形患者,全部采用全扩张“单瓣法”外耳再造。结果 术后随访3个月～3年,155例（162耳),其中5例术后出现再造耳术腔血肿,经更换负压引流管或穿刺抽血肿后治愈;5例术后出现软骨支架外露,经局部拉拢缝合、带蒂皮瓣转移或带蒂颞肌筋膜瓣覆盖外露软骨支架局部植皮修复等处理后治愈。全部病例最终均获得满意效果,再造耳廓位置与健耳对称,再造耳廓皮肤颜色正常,耳廓细微结构显示清晰。结论 全扩张“单瓣法”外耳再造效果确切,术后并发症少,是耳廓畸形患者外耳再造较为理想的方法。     

MEDPOR在肋软骨已钙化患者耳廓再造术中的应用

目的探讨对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,以MEDPOR作为再造耳廓支架的可行性。方法手术分为2期,1期是在残耳后埋置皮肤软组织扩张器,扩张皮瓣或瘢痕瓣。2期是以扩张皮瓣、耳后乳突区皮下筋膜瓣、残耳、MEDPOR支架、中厚皮片移植行耳廓再造术。自2009年1月---2014年1月,以此种方法行耳廓再造术34例,男性23例,女性11例,年龄32岁-61岁,均为单侧耳廓再造。结果 34例耳均顺利完成二期耳廓再造手术。术后随访时间,最短2年,最长5年7个月,形态令人满意,支架无外露发生。结论对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,MEDPOR支架是较为适合的再造耳廓支架材料。     

扩张皮瓣加筋膜瓣“两瓣法”在小耳畸形患者耳郭再造中的应用

目的 探讨带蒂扩张皮瓣加带蒂筋膜瓣“两瓣法”在先天性小耳畸形患者耳郭再造中的应用及效果。 方法 总结2012年1月至2018年1月期间712例(756耳)先天性小耳畸形患者,全部采用“两瓣法”行耳郭再造。 结果 术后随访1~6年,712例(756耳),其中15例(15耳)术后出现钢丝外露,经及时处理,拆除钢丝后治愈;10例术后出现再造耳郭皮下血肿,经更换负压引流管,引流通畅后,血肿消失;3例因术后患者保护不当,再造耳郭受压、碰伤导致软骨支架外露,经局部皮肤拉拢缝合,带蒂筋膜瓣覆盖表面植皮,及时处理后治愈。全部病例最终效果均满意,再造耳郭的大小、形态、位置与健耳对称,再造耳郭皮肤颜色正常,耳郭软骨支架无外露及吸收,细微凹凸结构显示清晰。 结论 “两瓣法”耳郭再造效果确切,术后并发症少,是先天性小耳畸形行耳郭再造较好的方法。     

改良Ⅱ期法耳廓再造术

目的 探讨改良Ⅱ期法耳廓再造的方法并总结6年来的临床应用经验。方法 对146例（155耳）小耳畸形患者行耳廓再造术,手术分Ⅱ期进行。Ⅰ期：采用“U”形切口,切除残耳,在耳后分离合适的腔隙,置入肋软骨耳支架,耳垂向后转位衔接于再造的耳廓下方。6个月后行Ⅱ期手术：掀起耳廓,耳后置入软骨块,颞浅筋膜瓣转移覆盖后行中厚皮片移植术。结果 146例患者中141例（150耳）Ⅰ期术后恢复顺利,伤口愈合良好;5例（5耳）Ⅰ期术后4～6d出现皮瓣尖端坏死,范围约1.0 cm×1.5 cm,经换药后痊愈,未出现软骨外露、感染等;139例（147耳）Ⅱ期术后耳后移植皮片成活良好,7例（8耳）Ⅱ期术后出现耳后移植皮片部分成活不良,换药1周后愈合。146例患者随访94例（97耳）,失访52例（58耳）,随访时间为术后6个月至2年,随访病例均无感染、软骨吸收等并发症,再造耳廓结构清晰,耳颅角稳定。结论 改良Ⅱ期法耳廓再造手术操作相对简单,易于掌握,是耳廓再造的较为理想的方法之一。     

双扩张器重叠埋置瘢痕皮肤扩张法修复烧伤后完全耳廓缺损

目的探讨采用双扩张器重叠埋置瘢痕皮肤扩张法在烧伤后耳廓全缺损修复中的临床应用。方法选取2014年7月～2016年1月烧伤后全耳廓缺损患者18例,采用双扩张器重叠埋置瘢痕皮肤扩张法进行全耳廓再造术,手术分两期进行:一期手术于耳后行扩张器埋置术,在患侧乳突区植入皮肤软组织扩张器80 mL和50 mL各一个;二期手术取出扩张器,在不牵拉耳后皮瓣的情况下适当切除颈部瘢痕,取自体肋软骨雕刻成耳支架,自耳后上方取颞浅筋膜瓣覆盖耳支架后方,耳后创面植以中厚皮片。结果 18例患者术后皮瓣血运良好,无坏死,植皮均成活。随访8～24个月,再造耳廓外形良好,双侧耳基本对称,皮肤色泽红润、感觉正常;移植肋软骨支架无排出、吸收和变形。结论双扩张器重叠埋置瘢痕皮肤扩张法修复烧伤后耳廓全缺损取得了较好的治疗效果,且无明显并发症,是可以作为烧伤后耳廓缺损的治疗方法。     

应用多孔高密度聚乙烯为支架的一期全耳廓再造

目的 探讨多孔高密度聚乙烯(Medpor)生物植入体的组织相容性。寻找外形理想,手术简便的外耳再造新方法。方法 以Medpor为耳廓支架,掀起耳后皮瓣及耳后筋膜瓣,将支架植入两者之间,并按合适的解剖位置固定于耳后乳突区骨膜上。耳后及筋膜组织瓣创面植皮。结果 自1998年3月～2000年12月,应用Medpor为支架一期再造耳廓8例,2例发生支架部分外露,经修补后未再发生外露现象,其余病例形态满意。结论 Medpor生物植入体组织相容性良好。以它做为支架再造耳廓,可免除患者胸部切取肋软骨造成的痛苦和畸形,且形态良好。但该植入体价格贵,质地硬是其不足之处。     

应用多孔高密度聚乙烯为支架的一期全耳廓再造

目的探讨多孔高密度聚乙烯(Medpor)生物植入体的组织相容性。寻找外形理想，手术简便的外耳再造新方法。方法以Medpor为耳廓支架，掀起耳后皮瓣及耳后筋膜瓣，将支架植入两者之间，并按合适的解剖位置固定于耳后乳突区骨膜上。耳后及筋膜组织瓣创面植皮。结果自1998年3月～2000年12月，应用Medpor为支架一期再造耳廓8例，2例发生支架部分外露，经修补后未再发生外露现象，其余病例形态满意。结论Medpor生物植入体组织相容性良好。以它做为支架再造耳廓，可免除患者胸部切取肋软骨造成的痛苦和畸形，且形态良好。但该植入体价格贵，质地硬是其不足之处。     

先天性小耳畸形的耳廓再造

目的探讨先天性小耳畸形的耳廓再造与重建方法。方法 2003年1月至2012年12月,采用皮肤软组织扩张法,利用健耳相片,通过计算机photoshop软件数字化翻转处理形成即要再造耳廓的相片,然后进行耳廓软骨支架的雕刻,用扩张后的患耳乳突区皮瓣覆盖雕刻的自体肋软骨耳廓支架行耳廓再造。结果 1102例(1165耳)经过6个月¹0年的随访观察。其中56例(56耳)再造耳廓有不同程度的软骨吸收、变形;2例(2耳)肋软骨支架感染、肋软骨液化、坏死;1044例(1107耳)再造耳廓与健耳匹配,凹凸结构显示清晰,形状相似、逼真,颅耳角的角度与健耳对称。结论用皮肤软组织扩张法行耳廓再造,术中应用数字化技术形成患耳相片指导自体肋软骨耳廓软骨支架的雕刻,效果满意、并发症少,是先天性小耳畸形较好的治疗方法。     

烧伤后耳廓缺损的修复

目的探讨烧伤后耳廓缺损的治疗方法。方法总结2003年1月—2010年6月期间25例(25耳)烧伤后耳廓缺损患者,局部瘢痕轻的19例(19耳)采用局部皮肤扩张自体肋软骨支架移植行耳廓再造,局部无正常皮肤的6例(6耳)应用颈部扩张皮瓣上提及自体肋软骨支架行耳廓再造。结果随访6个月～3年,25例(25耳)效果均满意:耳廓的位置、大小和健耳相似;移植的软骨支架无吸收、变形;再造耳廓皮肤色泽红润、感觉正常。结论皮肤扩张法自体肋软骨支架行耳廓再造,疗效满意、并发症少,是烧伤后耳廓缺损较好的治疗方法。     

Ten-year experience in microtia reconstruction using tissue expander and autogenous cartilage

OBJECTIVE: Ear reconstruction is a complex multi-staged procedure in otology. A variety of surgical strategies have been devised for the reconstruction. In this paper, we present our 10-year experience in microtia reconstruction using tissue expander and autogenous cartilage in microtia reconstruction. METHODS: The process of our method is divided into three stages. In the first stage, the kidney-shape tissue expander was implanted subcutaneously. With 1 month of inflation, the tissue expander offered the non-hairbearing and well-vascularized skin. In the second stage, we improved the technique of cartilage fabrication and used an expanded two-flap envelope to erect framework. In the third stage, the tragus and concha were reconstructed. RESULTS: 3332 patients have undergone ear reconstruction using tissue expander and autogenous cartilage from 1996 to 2006. The follow-up study showed the satisfactory contour of the reconstructed ears. CONCLUSIONS: Techniques using tissue expander and autogenous cartilage in microtia reconstruction was easily done and the complications were rare.     

带蒂颞肌筋膜隧道膜瓣在鼓室成形术中的应用

目的 探讨带蒂颞肌筋膜隧道皮瓣作为修补及支撑组织应用于鼓室成形术中的临床功效。方法 选择病变较轻的中耳炎96耳,其中46耳以带蒂颞肌筋膜隧道膜瓣为修补材料行鼓室成形术I型,另外50耳以游离颞肌筋膜修补鼓膜,作出对比;选择病变较重的中耳炎73耳,其中23耳去除外耳道后壁再以带蒂颞肌筋膜隧道膜瓣作为外耳道后壁软支架,另外50耳行乳突根治术,作出对比。结果 经过半年随访,转蒂移植的颞肌筋膜隧道皮瓣愈合良好,该组成活率为97.8％,游离颞肌筋膜组为88.0%,术后听力提高相仿。以带蒂颞肌筋膜瓣作为外耳道后壁软支架的病例组术后半年干耳率91.3%,乳突根治术半年干耳率92.0%,术后半年听力提高前者大于后者,行t检验提示有差别。结论 带蒂颞肌筋膜隧道膜瓣可作为良好的修补及支撑组织应用于慢性化脓性中耳炎的手术中。     

Mastoid fascia kite flap for cryptotia correction

ObjectiveCryptotia is one of the most common malformations of the upper auricle with aesthetic and functional consequences, however there is no standard treatment. We present the surgical technique and results of a kite flap procedure which can be used in the different cryptotia subtypes.MethodsWe reviewed all patients treated in our department from 2010 to 2015, using a mastoid fascia kite flap technique. The incision of this local flap follows the retro-auricular sulcus along the rim of the helix superiorly and drawing a skin paddle inferiorly. The mastoid fascia is exposed and a superiorly and posteriorly based flap is drawn and detached from the skull. Finally, the skin paddle is rotated and sutured between the superior helix and temporal skin creating the superior sulcus. The retro-auricular incision is closed directly inferiorly.ResultsSix patients (mean age 12) and seven ears were studied. One patient had bilateral cryptotia and only two had a normal contralateral ear. Mean follow-up was of 45 months. There was no skin necrosis, no complications reported and no revision surgery.ConclusionsWe describe a reliable flap with a simple design and improved aesthetic result, as the thickness of the flap projects the helix well, the scar is entirely hidden in the retro-auricular sulcus and the direct suture induces a harmonious medialization of the inferior part of the ear and earlobe.     

先天性外中耳畸形的Ⅰ期手术整复

目的 :探讨 期整复术治疗先天性外耳、中耳畸形和外耳道闭锁并存的患者的疗效。方法 :耳廓成形术 :取自体肋软骨作支架 ,患耳颞部超薄皮瓣及皮下组织瓣包裹软骨支架形成再造耳廓。鼓室成形术 :根据鼓室畸形情况作 型或大鼓室 型成形术 ;外耳道再造 :用全厚皮片移植。结果 :术后随访 4～ 6年 ,全部病例外耳道宽畅 ,成形鼓膜完整。语言频率听阈降低均达到应用水平 ;再造耳 11耳成活 ,8耳外形满意。结论 : 期整复术是治疗外耳、中耳畸形和外耳道闭锁并存的有效方法。     

Long-term outcome of the Hong Kong vascularized, pedicled temporalis fascia flap in reconstruction of mastoid cavity

OBJECTIVES: The vascularized, pedicled temporalis fascia flap (Hong Kong flap) is an established procedure in the reconstruction of the mastoid cavity. The long-term outcome and complications have not been studied. We set out to appraise this procedure in our study. STUDY DESIGN: The clinical records of 302 ears that had the Hong Kong flap procedure from 1987 to 2006 were retrospectively studied. The study reviewed the otologic complaints leading to Hong Kong flap, the number and findings of the second or more looks, analysis of procedures year by year, time to achieve a dry ear, and the complications. RESULTS: The main otologic complaint leading to use of the Hong Kong flap is otorrhoea. The number of Hong Kong flap procedures has decreased in recent years. Twenty-one percent had second or more looks after the procedure. Forty percent of the mastoid cavities at the second look were found to have residual or recurrent cholesteatoma. It takes a median of 2 months to achieve a dry ear after the procedure. CONCLUSIONS: We conclude that the Hong Kong flap procedure is simple and desirable for mastoid reconstruction to achieve a safe and dry cavity with few complications.     

Satisfactory surgical option for congenital microtia with defects of external auditory meatus (EAM) and middle ear

CONCLUSIONS: Improved appearance and hearing and increased efficiency are achievable for congenital microbia with defects of external auditory meatus (EAM) and middle ear. First the site of the external auditory meatus (EAM) orifice must be located according to the results of the temporal CT scan, then the auricle can be reconstructed employing the three-stage method. At the third stage, the EAM and middle ear can be reconstructed at the same time. OBJECTIVE: To select the best approach for reconstruction of congenital microtia with defects of the EAM and middle ear. PATIENTS AND METHODS: This study analyzed 498 cases (528 ears) of auricle reconstruction by the three-stage method and 77 cases (91 ears operation/120 ears) of EAM and middle ear reconstruction. RESULTS: For auricular reconstructions, the effects of reconstructed auricles were classified into four grades according to their structure verisimilitude and the bilateral symmetry. The majority of patients/families were satisfied. For 52 ears with normal movement of stapes, reconstructions of EAM and middle ear improved hearing by 15-50 dB, but long-term improvement was not ideal. In bilateral patients, 20 of 24 ears with reconstructed EAMs exhibited relapse of stenosis or atresia. For patients whose EAMs were reconstructed first, scar developed around the orifice and affected the skin flap and later auricle reconstruction, while reconstructing the auricle first sometimes resulted in the location of the EAM orifice deviating from an ideal position.     

The uvulopalatal flap for reconstruction of the soft palate

OBJECTIVE: To determine the indications, complications, and outcomes of the uvulopalatal flap in the reconstruction of defects of the soft palate. STUDY DESIGN: Retrospective review. METHODS: Patient data were obtained from the hospital records of 18 patients who had soft palate defects reconstructed with the uvulopalatal flap over a 5-year period at a tertiary academic medical center. RESULTS: Eleven patients had the uvulopalatal flap as the sole method of reconstruction, whereas this flap was used in combination with a radial forearm free flap, pectoralis flap, and skin graft in 4, 2, and 1 patients, respectively. All flaps were successful in soft palate reconstruction. One flap was successfully revised after additional tumor resection. A partial flap dehiscence occurred in one patient and healed uneventfully. Speech and swallowing function was dependent on initial tumor stage and the scope of tumor resection. CONCLUSIONS: The uvulopalatal flap is a simple and effective method of soft palate reconstruction either alone or in combination with other methods of reconstruction for selected oropharyngeal defects.     

Reconstruction of radical mastoidectomy by obliteration technique.

Reconstruction of radical mastoidectomy was performed by obliteration tympanoplasty using Palva flap in 199 ears either in one stage (normal mucosa, normal stapes, no risk of residual cholesteatoma behind the flap) or in two stages. At the 2nd stage, middle ear was reopened and the posterior cavity was checked in 34 cases. Bony paté or ceramic granules may be added behind the flap, especially at this second stage. The closure of the tympanic membrane was achieved in 97% of cases. Residual cholesteatoma was removed in the middle ear at the 2nd stage in 17% of the ears. Late residual cholesteatoma behind the flap appeared in 5 cases where the posterior cavity had not been checked. Three early retraction pockets were due to technical failures which were more recently corrected by the use of fibromuscular graft placed between the fascia graft an the Palva flap. Three late retraction pockets progressed under the tympanic membrane from above to below. Hearing results were better in the 1st stage procedures, obviously selected: ABG within 20 dB in 83% of the ears with a normal stapes. On the contrary, in 2 stage procedures, ABG within 20 dB was achieved only in 50% of cases with a normal stapes and 29% of the ears where the crura were missing.