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。

Modified two-stage surgery for total auriculoplasty with autogenous rib cartilage

Objective To introduce a modified surgery for total auriculoplasty and the experience in one hundred and forty-six cases( 155 ears). Methods The procedure was a two-stage operation. The first stage involved fabrication and grafting of a costal cartilage framework. A U-shaped skin incision was made on the posterior edge of the Iobule and the remnant ear cartilage was removed completely. The area for the insertion of the cartilage framework was undermined. Skin flaps were sutured after insertion of the eatilage framework. The second-stage surgery was usually performed six months after the first-stage operation. The reconstructed auricle was elevated, and a costal cartilage block was fixed to the posterior part of the auricle.A temporoparietal fascia flap was then used to cover the costal cartilage block. Finally, the posterior aspect of the projected auricle was covered with a spit-thickness skin graft. Results The incisions healed in one hundred and forty-one patients ( 150 ears) after the first stage operation. Partial necrosis of the postauricular flap was observed in five cases (5 ears)after the first stage operation, but no exposure or absorption of the cartilage took place. The skin grafts survived in one hundred and thirty-nine cases ( 147 ears) after the second-stage surgery. Partial necrosis of the skin graft was observed in seven cases(8 ears), but healed after one-week of dressing changes. Ninty-four cases (97 ears) were followed up, but fifty-two cases (58 ears)were lost to follow up. The follow-up at six months to two years showed satisfactory contour and projection of the constructed ears. Conclusion This two-stage surgery is simple and ideal for auricloplasty with few complications.