两种扩张筋膜皮瓣法耳再造效果比较.docVIP

两种扩张筋膜皮瓣法耳再造效果比较 　　[摘要]目的：探讨比较两种扩张筋膜皮瓣（简称：A组单纯耳后扩张皮瓣；B组，耳后联合双层筋膜皮瓣）包裹支架行全耳廓再造术的临床方法和效果。方法：对先天性小耳畸形患者均采用Medpor为支架，分别行两种皮瓣方式覆盖支架。A组：30例行耳后乳突区单纯扩张皮瓣包裹支架；B组：38例行耳后双层联合筋膜皮瓣包裹支架行全耳再造术。结果：A组30例患者中，出现血肿者2例，出现皮肤破溃假体外露1例，经局部换药皮瓣转移后创面痊愈。B组联合双层扩张耳后筋膜皮瓣38例患者中，术后耳部轮廓清晰，再造耳轮，对耳轮、耳甲腔等精细结构显现。供区无需植皮，色差及瘢痕均不显。结论：两种方法比较均获得较好的临床效果。其中耳后联合双层筋膜皮瓣法更能显现再造耳的微细结构，避免假体外露，为临床首选的一种好方法。 　　[关键词]耳再造术；筋膜皮瓣；扩张术；比较 　　[中图分类号]R764.7+1[文献标识码]A[文章编号]1008-6455（2014）07-0531-03 　　 　　Comparison of two kinds of expansion of the fascia flap ear reconstruction 　　ZHANG Ben-shou1,SHUI Xiang-bing1,XU Zhi-min1,XIE Chao1,XU Li-ping1,YANG Ji-shun1, 　　LIN Zi-hao2 　　(1.Department of Surgery,The 100thHospital of PLA,Suzhou 215007,Jiangsu,China;2.Department of Plastic Surgery,Shanghai Changzheng Hospital of PLA) 　　 　　Abstract:Objective To compare two full-ear reconstruction methodologies which use the expansion of the fascia flap (Group A: Expansion of the ear flap;Group B:Joint double ear flap fascia) to cover the support.MethodsUsing Medpor on congenital microtia patients perform two kinds of flaps to cover the support.Group A,30 cases used expanded flap of mastoid area behind the ear to wrap the support.Group B,38 cases used joint double ear flap fascia to wrap the support.ResultsIn group A,2 cases appeared hematoma and 1 case exposed support.The wounds were recovered after treatment.In group B, the reconstructed ears had lifelike appearance.Helix and ear cavity revealed fine structure.Reconstructed area appeared no significant color differences and scars.ConclusionsThe two methods presented both good effects.Especially the method of joint double ear flap fascia could avoid the exposed support and had lifelike ear structure.It is the ideal choice for full-ear reconstruction. 　　Key words:ear reconstruction;fascia flap; expansion technique;comparison 　　外耳是具有较复杂三维结构的体表器官，再造时要在平均33mm×66mm的范围内要显现出3层复杂的复合体和拥有15、16个解剖名词和亚单位结构[1]。目前国内外耳再造的方法主要有两种：乳突区局部皮瓣法[2]和扩张器法耳再造法[3-4]。两种方法都取自体肋软骨和Medpor假体作为耳支架[5]，均已取得较好的临床效果。手术方法的选择是该畸形治疗的