扩张器法全耳再造术在矫正先天性小耳畸形中的应用

发布时间：2019-06-08 12:50

【摘要】：目的：探讨一种利用扩张技术联合自体肋软骨移植矫正先天性小耳畸形的手术方式，即一期采用皮肤软组织扩张器扩张耳部皮肤，二期行皮肤软组织扩张器取出、耳软骨支架制作并植入扩张皮瓣形成再造耳郭，三期行耳甲腔加深、耳屏及耳垂再造等细节修整，共分三期完成的全耳再造手术。 方法：2012年4月至2013年2月，第四军医大学西京医院整形外科共收住276例先天性小耳畸形患者，其中男性197例、女性79例，右侧162例、左侧108例、双侧6例，年龄7~33岁，平均年龄16.7岁。一期手术选用“威宁”80ml肾形皮肤软组织扩张器埋置于残耳上方，术后定期、定量间断注水，持续注水扩张2~3个月；二期手术行皮肤软组织扩张器取出，肋软骨切取、雕刻，植入扩张皮瓣，形成再造耳的主体结构；二期术后至少3月后，视再造耳外形行局部修整手术，如加深耳甲腔，利用残耳组织再造耳垂及耳屏等，从而完成整个全耳再造过程。 结果：术后3年~2个月随访：一期埋置皮肤软组织扩张器术后出现扩张器外露4例，感染1例，血肿1例，扩张不良1例；二期术后出现耳部血肿3例，感染1例，软骨外露12例，胸部血肿1例，无皮瓣血运不良及坏死现象；三期术后出现软骨外露2例，无血肿、感染等发生。出现术后并发症患者中，除二期术后感染患者由于感染控制不佳导致耳软骨支架外形受损外，余患者经对症处理后均恢复良好，未对手术效果产生较大影响。除二期术后感染患者需行二次再造手术，其他患者再造耳外形良好，三维结构形象逼真，双侧耳郭形态、角度相似，患者及家属基本满意。 结论：采用本方法矫正先天性小耳畸形，，适用范围广，手术操作简单，风险较低，并发症少且易处理，安全经济。术后再造耳外形立体，三维结构清晰，皮肤颜色、质地均匀一致，与健侧耳外形、位置、角度等相似，患者及家属满意度高。
[Abstract]:Objective: to investigate a surgical method for correction of congenital small ear deformity by using dilatation technique combined with autologous costal cartilage transplantation, that is, the skin and soft tissue expander was used to dilate the ear skin in the first stage, and the skin and soft tissue expander was taken out in the second stage. The expanded skin flap was made and implanted to form the reconstructed auricle. The ear nail cavity was deepened, the ear screen and earlobe were reconstructed in the third stage, and the whole ear reconstruction operation was completed in three stages. Methods: from April 2012 to February 2013, 276 patients with congenital microauriculus were enrolled in the Department of plastic surgery, Xijing Hospital, fourth military Medical University, including 197 males, 79 females, 162 patients on the right side, 108 cases on the left side and 6 cases on both sides, aged 7 鈮

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