带蒂残耳复合组织瓣在再造耳修整中作用.docVIP

带蒂残耳复合组织瓣在再造耳修整中作用[摘要]目的:探讨如何合理有效地利用残耳组织，对再造耳进行局部修整的方法。方法:对12例单侧小耳畸形患者再造耳进行修整。患耳按耳廓发育情况分为：Ⅰ度3例，Ⅱ度9例。所有患者在三期再造耳修整时，残耳组织量充足，残耳软骨及皮肤量较多，再造耳外形尚可，存在狭小耳甲腔，再造耳的颅耳沟瘢痕粘连变浅。在粘连的颅耳沟区切开松解，并在原支架底部切开包裹支架的筋膜，使之与软骨皮瓣基底部相通，形成一颅耳沟区创面，再在残耳组织上设计比创面略大的梭形切口，在其两侧皮下剥离，保留软骨表面的软组织，形成蒂在底部的残耳复合组织瓣，将之通过支架下方的隧道转移至耳后区创面，缝合组织瓣与耳后创面边缘，供瓣区皮瓣适当改形后覆盖耳甲腔创面，以扩大耳甲腔。结果:转移至颅耳沟区的残耳复合组织瓣成活良好，耳支架高度明显增高，颅耳沟明显加深，耳甲腔明显扩大，随访3～6个月，再造耳无明显挛缩变形。结论：残耳组织在再造耳修整中是良好的材料，将其通过带蒂移植的方法转移至需要部位，不仅可明显改善再造耳的外观，而且可合理利用原有组织，而无需另取组织游离移植。 [关键词]带蒂残耳复合组织瓣；再造耳；修整术 [中图分类号]R764.7R622[文献标识码]A [文章编号]1008-6455（2008）10-1464-02 Prostheses of reconstructed ear by pedicle composite tissue flap of residual ear LIU Jia-feng,SUN Jia-ming,ZHANG Yi-ming (Department of Plastic and Reconstruction,Union Hospital,Tongji Medical College,Huazhong Science Technique University,Wuhan 430022,Hubei，China) Abstract:ObjectiveTo investigate the prostheses of reconstructed ear by pedicle composite tissue of residual ear effectly, in order to assess the value and indication of them.MethodsTwelve patients who suffered from Ⅰtype or Ⅱtype microtia were selected to use these methods.All of these patients had adequate residual ear tissue and the appearance of reconstructed ears were clear but not perfect. The skin was cut and the scar relaxed in the auriculocephalic sulcus which were shallow in the reconstructed ears.And there was a shuttle-shape wound remaind in the auriculocephalic sulcus. The shuttle-shape skin incisions which were analogous with the wound were made in the middle of residual ear,and then the cartilage-skin compsite flaps were made with the pedicle in the bottom of cavity of auricular concha.The cartilage-skin compsite flaps were then transplanted to the wounds in the auriculocephalic sulcus from the tunnels under theframeworks,and the margin of cartilage-skin flaps were then sutured to the margin of wound.The other skin of residual ear was then used to cover the wounds of cavity of auricular concha.ResultsAll the transplanted cartil