先天性小耳形的肋软骨全耳廓再造术.docxVIP

先天性小耳畸形的肋软骨全耳廓再造术　　作者褚燕军：安徽省立医院 整形烧伤外科副主任医师　　[摘要] 目的 探讨先天性小耳畸形应用自体肋软骨分两期行全耳廓再造术的手术方法。方法 从2006年～2008年对10例小耳畸形患者采用自体肋软骨分二期行全耳廓再造共11个，手术I期为耳解剖结构三维轮廓再造;Ⅱ期为颅耳角再造。结果 本组10例，9例手术顺利、效果满意，1例系双侧小耳，I期再造术后双侧皮瓣远端表皮坏死，自行脱痂痊愈。随访6～18个月，再造耳廓轮廓清晰，拥有良好的颅耳角。结论 应用自体肋软骨分两期行全耳廓再造，疗效满意，并发症少，是先天性小耳畸形理想的再造方法。　　[关键词] 先天性小耳畸形 自体肋软骨 全耳廓再造　　Total Auricular Reconstruction with Costal Cartilage for Congenital Microtia　　Chu Yanjun,Duxiaoyang,Wangminggang　　(Dept of Plastic and Burn Surgery,Provincial Hospital of Anhui Medical University,Hefei 230001)　　[Abstract] Objective To explore surgical procedure of tota auricular reconstruction with costal cartilage for congenital microtia in two-stage operation. Methods From 2006 to 2008,10 cases with microtia received two-stage operation for total reconstruction of the auricle,in which the first stage involved fabrication and grafting of the three-dimensional autologous costal cartilage framework and the second stage was ear elevation operation. Results The follow-upshows that the appearance of reconstructed ear is good with accurate size, shap and orientation, as well as precise anatomic duplications and well auriculocephalic angles. Among the 10 cases ,partial skin necrosis happened at the end of skin flap in 1 case with bilateral microtia, this problem was resolved with ointment dressing. Conclusion Total auricular reconstruction with costal cartilage in two-stage operation is considered to be an ideal surgical procedure for congenital microtia.　　[Key words] Congenital Microtia; Costal Cartilage; Total Auricular Reconstruction　　　　先天性小耳畸形是耳廓的先天性发育不良，常伴有外耳道闭锁、中耳畸形和颌面部畸形，发病率为1/7000～1/8000。其历经了Tanzer[1]和Brent[2-5]的四期耳廓再造术、Nagata[6-7]和Fimin[8]的二期耳廓再造术。我科从2006年～2008年应用自体肋软骨做耳支架及乳突区皮肤覆盖分二期行全耳廓再造共10例11耳，取得了满意的效果。现报道如下。　　材料和方法　　一、病例资料 收集2006年至2008年病房收治的先天性小耳畸形10例，其中男性7例，女性3例，年龄7岁～26岁;左侧3例，右侧6例，双侧1例;依Nagata分型，耳甲腔型2例，耳垂型8例。　　二、 手术方法 所有病例均采用气管插管全身麻醉，主要分两期进行，I期行外耳轮廓再造，包括肋软骨的切取和耳支架的雕刻，乳突区皮瓣的切取和耳支架的包埋，同期异位耳垂的转位和衔接;Ⅱ期行颅耳角再造，包括外耳廓的掀起、支撑软骨的充填、颞浅筋膜或耳后筋膜的覆盖、枕部皮瓣推进覆盖和皮片移植;后期耳支