耳后扩张皮瓣联合自体肋软骨移植修复耳轮部分缺损.docVIP

耳后扩张皮瓣联合自体肋软骨移植修复耳轮部分缺损[摘要]目的：探讨耳后扩张皮瓣联合自体肋软骨支架在修复耳轮部分缺损的应用。方法：对7例耳轮部分缺损的患者使用耳后扩张皮瓣联合自体肋软骨支架移植进行修复。结果：本组患者7例，男5例，女2例，均采用上述方法治疗，经过6个月～2年的随访，皮瓣全部成活，再造耳轮轮廓清晰，无卷曲变形，无支架外露。再造耳与健侧基本对称。结论：耳后扩张皮瓣联合自体软骨移植是修复耳轮部分缺损的一种简单有效的办法。 [关键词]耳轮缺损；皮肤扩张术；耳再造 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2011）03-0377-02 Reconstruction of segmental ear helix defect by using expanded postauricular skin flap combined with costal cartilage framwork YU Xiao-bo,JIANG Hai-yue,ZHUANG Hong-xing,PAN Bo,ZHAO Yan-yong,LIU lei (Auricular Reconstructive Center,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100144,China） Abstract:ObjectiveTo explore the method of repairing segmental ear helix defect by using expanded post auricular skin flap combined with costal cartilage framework.MethodsSeven patients with segmental ear helix defect were treated with method of expanded post auricular skin flap combined with costal cartilage framework.Results7 patients including 5 male and 2 female were all treated with this method. After a routinely follow-up of 6 months to 2 years,all flaps survived and reconstructed ear helices were in good shape without curling deformity, no cartilage framework exposure was found. The reconstructed ears were in symmetry to the healthy ones.ConclusionThe method is simple and effective for correction of segmental ear helix defect. Key words:ear helix defect；skin expansion：ear reconstruction 耳轮缺损是较为常见的一种耳廓外伤后畸形，通常需要采用手术的方法进行修复。目前对于外耳再造的手术方法报道较多，但是对单侧耳轮缺损术后疗效不一。2008年～2010年，笔者采用耳后扩张皮瓣联合自体肋软骨移植修复耳轮部分缺损，术后获得较满意效果，现报道如下。 1临床资料 本组7例患者，男5例，女2例，年龄6～23岁，手术方式均采用耳后扩张皮瓣联合自体肋软骨移植修复，术后10天拆线，随访6个月～2年，效果明显，皮瓣全部成活，再造耳轮轮廓清晰，无卷曲变形，无支架外露。再造耳与健侧基本对称。 2手术方法 手术分两期进行，一期手术耳后皮下埋置扩张器以制备耳后扩张皮瓣，扩张器埋置范围为“肾形”，面积约6cm×4cm。切口位于耳后距发际线0.5～1cm，长约3cm。0.5%的利多卡因加1:100 O00U肾上腺素行局部浸润麻醉后，切开并沿耳后浅筋膜浅层表面锐性剥埋置范围皮肤，创面以双极电凝止血后，将50ml肾形扩张器放置入剥离的囊腔中，放置引流管1根。切口分层缝合。术后3天拔除引流管，10天拆线。术后7天开始注水，常规每周注水3次，每次约5ml，注水总量为60ml左右后，维持1个月扩张静息期（图1）。二期手术术前以健侧耳廓制作胶片模片，患者采用静脉给药全身麻醉，