多孔高密度聚乙烯应用于扩张法耳廓再造术的临床研究

目的探讨应用多孔高密度聚乙烯（Medpor）作为再造耳支架对先天性小耳或后天耳廓缺失患者进行再造的可行性。方法1999年2月-2004年2月收治61例耳廓缺失患者，男38例，女23例；年龄5～61岁。先天性小耳40例，其中双侧1例，单侧39例．外伤后耳廓缺损21例，其中双侧6例，单侧15例。应用耳后软组织扩张法，以Medpor为支架行耳廓再造术。手术分二期，一期为耳后皮肤软组织扩张器置入术；二期为耳廓再造术。以耳后扩张皮瓣或扩张的耳后瘢痕瓣和乳突区皮下组织筋膜瓣包裹Medpor支架，再造耳廓。结果61例耳廓再造术患者均痊愈出院，获随访6个月～5年1个月，平均2．8年。其中49例（80．3％）患者对手术结果满意，7例（11．5％）认为再造耳手术效果尚可，3例（4．9％）发生了支架外露，对手术效果不满意，2例（3．3％）于术后6个月行自体肋软骨移植，置换Medpor支架。结论扩张法耳廓再造术中，对不适合、不能或不愿取用自体肋软骨作为再造耳支架的患者，应用Medpor耳支架，是一种较为安全、简便及可行的方法。

CLINICAL STUDY ON EXTERNAL EAR RECONSTRUCTION USING EXPANDED POSTAURICULAR FLAP AND MEDPOR FRAMEWORK

Objective To explore the feasibility of applying porous high density polyethylene (Medpor) as framework for auricle reconstruction of congenital or acquired auricular defects. Methods From February 1999 to February 2004, 61 patients suffering from congenital or acquired auricular defects underwent auricle reconstruction with Medpor framework after expanding postauricular skin. Among them, there were 38 males and 23 females, aging from 5 to 61 years. In 40 cases of congenital microtia, two sides were involved in 1 case and one side in 39 cases. In 21 cases of traumatic auricle damage, two sides were involved in 6 cases and one side in 15 cases. The operation was performed by two stages. First stage:the expander was implanted underneath postauricular skin or soft tissue such as notrophic scar tissue for the traumatic auricle defect. Second stage:the expander was removed and auricle reconstruction was performed by placing Medpor framework between the expanded skin/scar flap and the underlying fascial flap. Results Sixty-one patients obtained successfully reconstructed auricles. During a follow-up of 6 months to 5 years and 1 month (mean 2.8 years), the results were excellent and good in 49 cases (80.3%) , fair in 7 cases (11.5%) and poor in 3 cases (4.9%),2 cases (3.3%) underwent replacement of Medpor framework with autogenous costal cartilage after 6 months of operation. Conclusion Medpor framework would be applied safely, simply and reliably in condition that auricular framework is unfit or reluctant to undergo auricle reconstruction by using autogenous costal cartilage.