耳垂型小耳畸形再造耳廓细节性修整.docVIP

耳垂型小耳畸形再造耳廓细节性修整[摘要]目的:探讨耳垂型小耳畸形再造耳廓的细节性修整方法。 方法:再造耳廓的细节性修整包括耳屏成形、耳轮脚构建和耳甲腔加深;如果需要进行再造耳廓和对侧正常耳廓高度的对称性调整,则进行残耳软骨筋膜瓣的肋软骨支架下的牢固填充。结果:2004年1月～2008年12月共完成耳垂型小耳畸形耳廓再造细节性修整1427只,其中应用残耳软骨筋膜瓣行再造耳廓高度增加396只。157例患者随访1～3年,耳屏、耳轮脚结构形态逼真、残耳软骨能牢固支撑肋软骨支架,耳廓立体感强。结论:耳垂型小耳畸形再造耳廓细节性修整方法简单、操作方便,再造耳廓形态自然、对称性良好。 [关键词]小耳畸形;耳垂型;耳廓再造;残耳软骨筋膜瓣 [中图分类号]R764.9[文献标识码]A[文章编号]1008-6455(2010)01-0033-03 Refinement of reconstructed ear in lobule-type microtia WANG Shu-jie,PAN Bo,JIANG Hai-yue,ZHUANG Hong-xing,YANG Qing-hua,ZHAO Yan-yong,HE Le-ren,HAN Juan,LIN Lin (First Part of Northern Ward of Plastic Surgery Hospital,Chinese Academy of Medical Science,Beijing 100144,China) Abstract: ObjectiveTo explore the refinement of reconstructed ear in lobule-type microtia.MethodsThe process of the refinement of reconstructed ear in lobule-type microtia consisted of the tragus reconstruction, the crus reconstruction and deepening of conchal cavity. The remnant ear cartilage flap was transposed under the rib cartilage framework to acquire firm elevation if the symmetric adjustment was needed.ResultsFrom January 2004 to December 2008, 1427 reconstructed ears were refined and the remnant ear cartilage flaps were used in396 cases. Through 1 to 3 years follow-up, the tragus and crus was vivid. The reconstructed ear was firmly elevated by the remnant ear cartilage and had a three-dimensional contour.ConclusionsTherefinement of reconstructed ear in lobule-type microtia was easily manipulated. The reconstructed ear had a natural-looking contour and was symmetric with the normal ear. Key words: microtia; lobule-type; ear reconstruction; remnant ear cartilage flap 小耳畸形根据残耳形态通常分为耳垂型、小耳甲腔型和耳甲腔型,耳垂型是最为典型和常见的小耳畸形[1-3]。耳垂型小耳畸形伴有外耳道闭锁,乳突区的骨膜表面被残耳软骨及其软组织充填,因此再造耳廓往往存在耳甲腔过浅、耳屏缺失、耳轮脚显现不清晰等不足。笔者于2004～2008年实施再造耳廓的细节性修整,经过修整后再造耳廓的耳屏、耳甲腔和耳轮脚等细微结构更为逼真,再造耳廓和对侧正常耳廓高度对称,现将主要经验总结如下。 1方法 再造耳廓的细节性修整包括耳屏成形、耳轮脚构建和耳甲腔加深,如果需要进行再造耳廓和健侧耳廓高度的对称性调整,则将残耳软骨筋膜瓣移植至肋软骨耳廓支架下,以利于增加再造耳廓的高度。 1.1耳屏成形:于再造耳廓的耳甲腔区域皮肤表面设计半径约1.0cm的半圆形