MEDPOR支架耳廓再造术及支架外露的处理

目的 探讨应用MEDPOR(多孔高密度聚乙烯)支架再造耳廓治疗先天性小耳畸形的优缺点，以及支架外露后的处理办法。方法 手术分两期进行，第1期行残耳整形和耳后乳突区皮肤扩张器埋置术；第Ⅱ期取出皮肤扩张器，置入MEDPOR支架，再造耳廓。结果 从1999年至今，应用MED—POR支架治疗7例先天性小耳畸形。3例Ⅰ期愈合，外形良好，另4例发生支架外露，且1例外露部位伴有感染，经采用局部皮瓣或颞浅筋膜岛状瓣修复后，都保留了支架，并获得痊愈，外形亦佳。结论 MEDPOR耳廓支架具有良好的组织相容性，血管可以长入其中，即使外露亦不需取出。具有操作简便，手术时间短，创伤小的优点。虽然支架外露的发生率较高，但仍不失为是自体肋软骨支架再造耳廓的一种较好的替代材料。

Microtia reconstruction by MEDPOR framework and treatment of the framework exposure

Objective To evaluate the result of microtia reconstruction by MEDPOR framework plantation, and also to explore the treatments of framework exposure. Methods It needed two stages to finish the whole procedure. At the first stage, the lobular remnant was transposed and a 50 ml renal shaped tissue expander was placed at the retroauricular area for skin expansion. Injection of the saline began at the third week after the operation, twice a week for 5-10ml each time until reached 50ml. At the second stage, the retroauricular cutaneous flap was used to wrap the MEDPOR framework inside, and the posterior side of the ear was covered by a full-thickness skin graft. Results Seven cases of microtia have been treated by using the MEDPOR framework in our department since 1999. 3 cases were cured without any complications, including the case that the reconstruction was done in one stage without skin expansion. Other 4 cases were found to have the framework partially exposed. The locations of the MEDPOR framework exposure were 4 cases at helix, 1 case at tragus, 2 cases at earlobe, and 1 case at superior crust. All the cases needed re-operations by means of local flap or the superior temporal fascial flap. One of them was also accompanied by infection that was cured by dissection of the exposed framework and covered a local skin flap. None of the framework was taken out because of the exposure or infection. All had gained good cosmetic results at last. Conclusion MEDPOR framework has good histocompatibility so that the blood vessels can easily get into it. When the exposure of the flap occurs, it is not necessary to take out the whole framework but just cover the exposed areas with a local skin flap. The operation is relatively simple and less time-consuming with minor damage to the patient. Although skin expansion at the first stage may cause a relatively high framework exposure rate because it is too thin to cover the relatively hard framework, it gets better cosmetic results. We suggest that the retroauricular fascial flap be big enough to wrap the whole helix inside without any tension to reduce the risk of exposure.Therefore, MEDPOR framework is a good substitute for the rib cartilage framework.