三维自体肋软骨耳廓支架外耳再造术

目的评估三维自体肋软骨耳廓支架外耳再造的手术方法及效果。方法122例应用三期法即一期扩张器埋置，患耳皮肤扩张；二期自体肋软骨雕刻成三维支架行耳廓再造；三期耳甲、耳屏重建的方法再造外耳。结果122例一期行扩张器埋置术后，并发感染致扩张器取出2例，改为一期行外耳再造术；扩张器外露3例，提前行二期耳廓再造术。二期行耳廓再造术后，并发感染3例，经换药后愈合。耳轮软骨外露3例，经转移筋膜瓣植皮后修复。三期手术后经随访3～24个月，17例再造耳有不同程度的软骨吸收、变形外，105例再造耳廓的形态、大小、位置与健耳相似，均外形良好，细微结构清晰。结论应用皮肤扩张、自体肋软骨雕刻成形三维立体耳支架再造外耳方法安全可靠、再造外耳形态逼真。

Auricular reconstruction with 3-dimensional autogenous costal cartilage framework of the auricle

Objective To evaluate the method and effect of auricular reconstruction with 3- dimensional autogenous costal cartilage framework of the auricle.Methods A three-stage auricular reconstruction was applied.In the first stage,a tissue expander was inserted to expand the skin in the mastoid region. In the second stage,a 3-dimensional,contour-accentuated ear framework fabricated with autogenous costal cartilage was used to reconstruct the auricle,and in the third stage,tragus construction and conchal excavation were performed.Results One hundred and twenty-two patients received auricular reconstruction.After first stage operation of expander insertion,two cases developed infection,and then the expanders were removed.Three cases had exposure of the expander,and the second stage operation was performed ahead of time.After the second stage operation of auricular reconstruction, three cases developed infections,three cases had exposure of ear rim(recovered by fascial flap and skin graft).After three-stage operation,the auricular reconstruction was excellent,subtle contour during 3 to 24 months follow-up period.Their shape,size and position were similar to the other sides except that 17 cases of them had different degree of cartilage resorption and distortion. Conclusion Auricular reconstruction with skin expansion and 3-dimensional autogenous costal cartilage framework of the auricle is a safe and effective treatment,which has good contour with sharp outlines.