耳后双蒂扩张皮瓣法耳廓再造术

目的探讨耳后双蒂扩张皮瓣在耳廓再造术中的应用效果。方法回顾性分析2016年9月至2017年8月中国医学科学院整形外科医院整形七科收治的符合纳入、排除标准的全部先天性小耳畸形患者的临床资料。手术方法:一期行扩张器置入,二期采用耳后双蒂扩张皮瓣覆盖耳支架,耳后筋膜包裹耳支架外耳轮,联合耳后上极游离植皮重建耳廓。患者于术后1、6个月及三期手术前进行复查,由两名未参与手术的初级医生在患者三期手术前复查时对其再造耳廓形态进行评价,如有分歧,则由上级医生进行最终评价,评估结果分为好、中等、差。结果共纳入46例先天性小耳畸形患者(49只耳),男36例(39只耳),女10例(10只耳),年龄6~23岁。其中3例患者(3只耳)术后5 d拔除引流管时双蒂扩张皮瓣下有积血,经负压抽吸和换药后恢复良好。术后随访6~18个月,43例(46只耳)再造耳形态评价为好,患者双侧耳廓大小和位置对称,再造耳廓三维结构完整、清晰,形态良好,色泽均一,瘢痕位于耳后发际线处,位置隐蔽,可被头发遮盖,乳突区色泽佳;3例(3只耳)再造耳形态评价为良,术后5 d拔除引流管时有积血,经负压抽吸及换药后完全成活,未见耳支架感染及外露。结论耳后双蒂扩张皮瓣血运可靠,再造耳廓形态自然,瘢痕隐蔽,皮肤色差小,是耳廓再造时包裹耳支架的良好选择。

Auricular reconstruction using an expanded postauricular flap with double pedicle

Objective To investigate the clinical effect of auricle reconstruction using an expanded postauricular flap with double pedicle in the ear reconstruction.Methods From September 2016 to August 2017,the clinical data of all patients with congenital microtia treated in the Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences were analyzed retrospectively.The surgical procedures:The expander was implanted in the first stage.The ear framework was covered by the retroauricular double-pedicled expanded flap with free skin grafting at the retroauricular superior margin in the second stage,and the helix was wrapped by the retroauricular fascia.The patients were followed up at 1,6 months after operation and before the third stage operation,and the appearance of the reconstructed auricle was evaluated by two junior doctors before the third stage of the operations.If there were any differences,the final evaluation would be carried out by a senior doctor.The evaluation results were good,medium and poor.Results A total of 46 patients(49 ears)with congenital microtia were included,including 36 males(39 ears)and 10 females(10 ears),with the age range of 6-23 years.After operation,the blood supply was good,and the skin grafts survived completely.Three ears had postoperative hematomas under the double-pedicled expanded skin flap when the drainage was removed 5 days after operation.The hematomas recovered well after the negative pressure suction and dressing changed.During the follow-up of 6 months and 18 months,43 cases(46 ears)were evaluated well with symmetrical and clear three-dimensional structure of reconstructed auricles,uniformed color,and hidden scar behind the ear.Three cases(3 ears)were evaluated as medium.There was hematoma when the drainage tube was removed 5 days after operation,which survived completely after negative suction and dressing change.No cartilage framework infection and exposure were found.Conclusions The double-pedicled expanded flap has many advantages,such as reliable blood supply,natural auricle appearance,concealed scar,and less skin color difference.It is a good choice for soft tissue wrapping and covering during auricle reconstruction.