皮肤扩张法耳再造术治疗先天性小耳畸形的临床应用
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摘要
目的：讨论应用皮肤扩张法耳郭再造术治疗先天性小耳畸的手术方法，总结其优势及不足。
方法：根据我科2008年12月-2011年12月16例采用皮肤扩张法耳郭再造术治疗的小耳畸形综合症患者，讨论皮肤扩张法耳郭再造术的手术方法。手术主要为两期，即一期扩张器置入，二期取自体肋软骨雕刻成耳支架，用耳后筋膜瓣和耳后扩张皮瓣覆盖支架。后可依术后具体情况按照患者需要选择性行三期耳屏再造，耳甲腔加深及修整局部形态等手术。
结果：16例患者均手术顺利，术后再造耳形态良好，患者满意。2例患者一期手术后出现血肿，未发生感染或扩张器外露。1例扩张器植入术后出现注射壶处慢性渗液，经二期肋软骨雕刻耳再造手术后再造耳形态良好。1例出现皮瓣远端表皮坏死，结痂脱落后自行痊愈,无软骨外露，未影响再造耳外形。随访6—12个月，再造耳形态良好，耳颅角成形佳，移植的软骨支架未出现吸收、软化、变形，再造耳位置、大小，形态均与健侧相似。
结论：扩张器法耳郭再造术成功率高，术后再造耳形态逼真，是治疗先天性小耳畸形理想的手术方式。
Objective: Discussion the operative techniques of auricle reconstruction using soft tissueskin expander，and summarize their advantages and disadvantages.
Method: A total of16cases of auricle reconstruction using soft tissue skin expander wasperformed from December2009to December2011.Discussion the auriclere constructionsurgery using soft tissue skin expander according to the clinical data.The surgery havetwo stages,the one-stage operation is implanting soft tissue skin expander，the two-stageoperation is carveing autogenous rib cartilage framework and covering with fascial flapand expanded flap.Then tragus reconstruction,cavity of concha deepen operation, andlocal shape trimming operation can be performed according to requirement of patients.
Result:The16patients of microtia were treated successfully.Two cases occurredhematoma after the one-stage operation.One case occurred chronic effusion at theinjection pot,but the reconstructed ear was in good shape after auricle reconstruction. Inother one case,the distal part of the flap was necrotic,then had healed after scabs felloff.After6-12months following up, the reconstructed ears were all in good shapewithout distortion and cartilage resorption, the locations, sizes and appearances ofreconstructed ears were similar to uninjured sides.
Conclusion: The auricle reconstruction using soft tissue skin expander have a highsuccess rate,the shape of reconstructed ear are lifelike.At present time, it was a goodmethod to use soft tissue skin expander in auricle reconstruction.
方法：根据我科2008年12月-2011年12月16例采用皮肤扩张法耳郭再造术治疗的小耳畸形综合症患者，讨论皮肤扩张法耳郭再造术的手术方法。手术主要为两期，即一期扩张器置入，二期取自体肋软骨雕刻成耳支架，用耳后筋膜瓣和耳后扩张皮瓣覆盖支架。后可依术后具体情况按照患者需要选择性行三期耳屏再造，耳甲腔加深及修整局部形态等手术。
结果：16例患者均手术顺利，术后再造耳形态良好，患者满意。2例患者一期手术后出现血肿，未发生感染或扩张器外露。1例扩张器植入术后出现注射壶处慢性渗液，经二期肋软骨雕刻耳再造手术后再造耳形态良好。1例出现皮瓣远端表皮坏死，结痂脱落后自行痊愈,无软骨外露，未影响再造耳外形。随访6—12个月，再造耳形态良好，耳颅角成形佳，移植的软骨支架未出现吸收、软化、变形，再造耳位置、大小，形态均与健侧相似。
结论：扩张器法耳郭再造术成功率高，术后再造耳形态逼真，是治疗先天性小耳畸形理想的手术方式。
Objective: Discussion the operative techniques of auricle reconstruction using soft tissueskin expander，and summarize their advantages and disadvantages.
Method: A total of16cases of auricle reconstruction using soft tissue skin expander wasperformed from December2009to December2011.Discussion the auriclere constructionsurgery using soft tissue skin expander according to the clinical data.The surgery havetwo stages,the one-stage operation is implanting soft tissue skin expander，the two-stageoperation is carveing autogenous rib cartilage framework and covering with fascial flapand expanded flap.Then tragus reconstruction,cavity of concha deepen operation, andlocal shape trimming operation can be performed according to requirement of patients.
Result:The16patients of microtia were treated successfully.Two cases occurredhematoma after the one-stage operation.One case occurred chronic effusion at theinjection pot,but the reconstructed ear was in good shape after auricle reconstruction. Inother one case,the distal part of the flap was necrotic,then had healed after scabs felloff.After6-12months following up, the reconstructed ears were all in good shapewithout distortion and cartilage resorption, the locations, sizes and appearances ofreconstructed ears were similar to uninjured sides.
Conclusion: The auricle reconstruction using soft tissue skin expander have a highsuccess rate,the shape of reconstructed ear are lifelike.At present time, it was a goodmethod to use soft tissue skin expander in auricle reconstruction.
引文
[1]潘博,国冬军,蔡霞,等.先天性小耳畸形研究现状和进展[J].中华医学美容,2007,16(7):1007-1012.
[2]曹玲,曹军.先天性小耳畸形扩张器法外耳再造术105例分析[J].中国误诊学杂志,2010,10(28):6962.
[3]庄洪兴,蒋海越,潘博,等.先天性小耳畸形的皮肤软组织扩张器法外耳再造术[J].中华整形外科杂志,2006,22(4):286-289．
[4]Park C.Subfascial expansion and expanded two-flap method for microtiareconstruction[J].Plast Reconstr Surg,2000,106(7):1473-1487.
[5] Toll ef son T. Advances in the treatment of microtia[J]. Curr Opini Otolaryngol HeadNeck Surg,2006,14(6):412-422.
[6]蒋海越,国冬军,等.先天性小耳畸形乳突区扩张皮肤血管分型及其临床意义[J].中华整形外科杂志,2007,23(5):178-182.
[7] Pan B，Jiang H，Guo D，et a1．Microtia：ear reconstruction using tissue expanderand autogenous costal cartilage[J].Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：S98-S103．
[8] Jiang H，Pan B，Lin L，et a1．Fabrication of threedimensional cartilaginousframework in auricular reconstruction[J]．Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：77-85．
[9] Tae Sung Lee, So Young Lim, Jai Kyong Pyon,et al. Secondary revisions due tounfavourable results after microtia reconstruction[J]. Journal of Plastic, Reconstructiveand Aesthetic Surgery,2009,63:940-946.
[10]于仁义,李江,陈存富,等.超薄扩张皮瓣自体肋软骨支架耳廓再造术[J].中国美容医学,2006,15(9):1054-1055.
[11] Kelley PE，Scholes MA．Microtia and congenital aural atresia[J]．Otolaryngol ClinNorth Am,2007，40(1)：61-81．
[12]刘明生．扩张法自体肋软骨全耳廓再造的体会[J]．整形再造外科杂志，2004，1(3)：187-189
[13] Firmin F．Ear reconstruction in cases oftypical microtia：Personal experiene basedon352microtic ear corrections[J]．Scand J Plast Reconstr Surg Hand Surg，1998，32(1)：35-47．
[14] Brent B．Microtia repair with rib cartilage grafts：a review of personal experiencewith1000cases[J]．Clin Plast Surg，2002，29(2)：257-271．
[15]纪郁郁,李朝阳,郭智龙.扩张器扩张无需植皮在耳廓再造术中的应用[J].中国医疗前沿，2011,35（3）：12-13.
[1] SuutarlaS， RautioJ， RitvanenA,et al.Microtia in Finland:comparision ofCharaeteristics in different PoPulations[J]. Int J Pediatr Otorhinolaryllgol,2007,71(8):1211-1217.
[2]刘海军，熊猛.先天性小耳畸形病因学研究进展[J].中国美容医学，2009，18(4)：574-576.
[3]杜佳梅，郭万厚，韩娟，等．先天性小耳畸形危险因素的病例对照研究[J]．中华耳鼻咽喉头颈外科杂志，2006，4l(2)：107-111．
[4] MooreKL，PersandTV.Before we are born:Essentials of embryology and birthdefects[J].PhiladelPhia Saunders,1993:118.
[5] Kloekars T,RautioJ.Embryology and epidemiology of mierotia[J].Faeial PlastSurg,2009,25:145-148.
[6]饶兴旺,尹时华.先天性小耳畸形研究现状及进展[J].国际耳鼻喉头颈外科学杂志，2011,35（3）：149-152.
[7]杜佳梅;庄洪兴,蒋海越等.先天性小耳畸形患者及其家属心理状况调查[J].研究中华整形外科杂志,2005,21(3):218-222.
[8]戚可名，博洁，熊斌等.国人耳廓发育调查一兼论外耳再造的年龄选择[J].中华整形烧伤外科杂志，1990，6(2):136一137.
[9] Kelley PE，Scholes MA．Microtia and congenital aural atresia[J]．Otolaryngol ClinNorth Am,2007，40(1)：61-81．
[10]曹玲,曹军.先天性小耳畸形扩张器法外耳再造术105例分析[J].中国误诊学杂志,2010,10(28):6962.
[11]庄洪兴,蒋海越,潘博,等.先天性小耳畸形的皮肤软组织扩张器法外耳再造术[J].中华整形外科杂志,2006,22(4):286—289．
[12] BruceS， Bauer MD.Reconstruction of Microtia[J]. Plastic Reconstr Surg.2009,124:14-26.
[13] Toll ef son T. Advances in the treatment of microtia[J]. Curr Opini OtolaryngolHead Neck Surg,2006,14(6):412-422.
[14] Brent B．Microtia repair with rib cartilage grafts：a review of personal experiencewith1000cases[J]．Clin Plast Surg，2002，29(2)：257-271．
[15] Firmin F．Ear reconstruction in cases oftypical microtia：Personal experiene basedon352microtic ear corrections[J]．Scand J Plast Reconstr Surg Hand Surg，1998，32(1)：35-47．
[16]纪郁郁,李朝阳,郭智龙.扩张器扩张无需植皮在耳廓再造术中的应用[J].中国医疗前沿，2011,35（3）：12-13.
[17] Pan B，Jiang H，Guo D，et a1．Microtia：ear reconstruction using tissue expanderand autogenous costal cartilage[J].Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：S98-S103．
[18] Cho BC，Lee SH．Surgical results of two-stage reconstruction of the auricle incongenital microtia using an autogenous costal cartilage alone or combined withcanaloplasty[J]．Plast Reconstr Surg，2006，117(3)：936-947．
[19] BrentB．The correction of microtia with autogenous cartelage grafts：I.The classicdeformity[J]．Plast Reconstr Surg,1980，66(1):1-12．
[20] Brent B．The correction of microtia with autogenous cartelage grafts：II．Atypicaland complex deformities．Plast Reconstr Surg,1980，66(1)：13-24．
[21]江晨艳,石润杰,吴晴伟,等.自体肋软骨+Medpor耳基复合耳廓支架行全耳廓再造术[J].中国组织工程研究与临床康复,2008,2(1):97-99.
[22] Vacanti CA．Tissue engineered morphogenesis of cartilage and bone by Incans ofcell transplantation using synthe biodegradable polymer matriees[J].Plast Sarg,1994,2(1):445．
[23]吴建明,吴包金,林子豪,等.四种耳廓支架材料与临床应用评估[J].中国实用美容外科杂志,2004,15(6):297-298.
[2]曹玲,曹军.先天性小耳畸形扩张器法外耳再造术105例分析[J].中国误诊学杂志,2010,10(28):6962.
[3]庄洪兴,蒋海越,潘博,等.先天性小耳畸形的皮肤软组织扩张器法外耳再造术[J].中华整形外科杂志,2006,22(4):286-289．
[4]Park C.Subfascial expansion and expanded two-flap method for microtiareconstruction[J].Plast Reconstr Surg,2000,106(7):1473-1487.
[5] Toll ef son T. Advances in the treatment of microtia[J]. Curr Opini Otolaryngol HeadNeck Surg,2006,14(6):412-422.
[6]蒋海越,国冬军,等.先天性小耳畸形乳突区扩张皮肤血管分型及其临床意义[J].中华整形外科杂志,2007,23(5):178-182.
[7] Pan B，Jiang H，Guo D，et a1．Microtia：ear reconstruction using tissue expanderand autogenous costal cartilage[J].Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：S98-S103．
[8] Jiang H，Pan B，Lin L，et a1．Fabrication of threedimensional cartilaginousframework in auricular reconstruction[J]．Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：77-85．
[9] Tae Sung Lee, So Young Lim, Jai Kyong Pyon,et al. Secondary revisions due tounfavourable results after microtia reconstruction[J]. Journal of Plastic, Reconstructiveand Aesthetic Surgery,2009,63:940-946.
[10]于仁义,李江,陈存富,等.超薄扩张皮瓣自体肋软骨支架耳廓再造术[J].中国美容医学,2006,15(9):1054-1055.
[11] Kelley PE，Scholes MA．Microtia and congenital aural atresia[J]．Otolaryngol ClinNorth Am,2007，40(1)：61-81．
[12]刘明生．扩张法自体肋软骨全耳廓再造的体会[J]．整形再造外科杂志，2004，1(3)：187-189
[13] Firmin F．Ear reconstruction in cases oftypical microtia：Personal experiene basedon352microtic ear corrections[J]．Scand J Plast Reconstr Surg Hand Surg，1998，32(1)：35-47．
[14] Brent B．Microtia repair with rib cartilage grafts：a review of personal experiencewith1000cases[J]．Clin Plast Surg，2002，29(2)：257-271．
[15]纪郁郁,李朝阳,郭智龙.扩张器扩张无需植皮在耳廓再造术中的应用[J].中国医疗前沿，2011,35（3）：12-13.
[1] SuutarlaS， RautioJ， RitvanenA,et al.Microtia in Finland:comparision ofCharaeteristics in different PoPulations[J]. Int J Pediatr Otorhinolaryllgol,2007,71(8):1211-1217.
[2]刘海军，熊猛.先天性小耳畸形病因学研究进展[J].中国美容医学，2009，18(4)：574-576.
[3]杜佳梅，郭万厚，韩娟，等．先天性小耳畸形危险因素的病例对照研究[J]．中华耳鼻咽喉头颈外科杂志，2006，4l(2)：107-111．
[4] MooreKL，PersandTV.Before we are born:Essentials of embryology and birthdefects[J].PhiladelPhia Saunders,1993:118.
[5] Kloekars T,RautioJ.Embryology and epidemiology of mierotia[J].Faeial PlastSurg,2009,25:145-148.
[6]饶兴旺,尹时华.先天性小耳畸形研究现状及进展[J].国际耳鼻喉头颈外科学杂志，2011,35（3）：149-152.
[7]杜佳梅;庄洪兴,蒋海越等.先天性小耳畸形患者及其家属心理状况调查[J].研究中华整形外科杂志,2005,21(3):218-222.
[8]戚可名，博洁，熊斌等.国人耳廓发育调查一兼论外耳再造的年龄选择[J].中华整形烧伤外科杂志，1990，6(2):136一137.
[9] Kelley PE，Scholes MA．Microtia and congenital aural atresia[J]．Otolaryngol ClinNorth Am,2007，40(1)：61-81．
[10]曹玲,曹军.先天性小耳畸形扩张器法外耳再造术105例分析[J].中国误诊学杂志,2010,10(28):6962.
[11]庄洪兴,蒋海越,潘博,等.先天性小耳畸形的皮肤软组织扩张器法外耳再造术[J].中华整形外科杂志,2006,22(4):286—289．
[12] BruceS， Bauer MD.Reconstruction of Microtia[J]. Plastic Reconstr Surg.2009,124:14-26.
[13] Toll ef son T. Advances in the treatment of microtia[J]. Curr Opini OtolaryngolHead Neck Surg,2006,14(6):412-422.
[14] Brent B．Microtia repair with rib cartilage grafts：a review of personal experiencewith1000cases[J]．Clin Plast Surg，2002，29(2)：257-271．
[15] Firmin F．Ear reconstruction in cases oftypical microtia：Personal experiene basedon352microtic ear corrections[J]．Scand J Plast Reconstr Surg Hand Surg，1998，32(1)：35-47．
[16]纪郁郁,李朝阳,郭智龙.扩张器扩张无需植皮在耳廓再造术中的应用[J].中国医疗前沿，2011,35（3）：12-13.
[17] Pan B，Jiang H，Guo D，et a1．Microtia：ear reconstruction using tissue expanderand autogenous costal cartilage[J].Plast Reconstr Aesthetic Surg，2008，61(Suppl1)：S98-S103．
[18] Cho BC，Lee SH．Surgical results of two-stage reconstruction of the auricle incongenital microtia using an autogenous costal cartilage alone or combined withcanaloplasty[J]．Plast Reconstr Surg，2006，117(3)：936-947．
[19] BrentB．The correction of microtia with autogenous cartelage grafts：I.The classicdeformity[J]．Plast Reconstr Surg,1980，66(1):1-12．
[20] Brent B．The correction of microtia with autogenous cartelage grafts：II．Atypicaland complex deformities．Plast Reconstr Surg,1980，66(1)：13-24．
[21]江晨艳,石润杰,吴晴伟,等.自体肋软骨+Medpor耳基复合耳廓支架行全耳廓再造术[J].中国组织工程研究与临床康复,2008,2(1):97-99.
[22] Vacanti CA．Tissue engineered morphogenesis of cartilage and bone by Incans ofcell transplantation using synthe biodegradable polymer matriees[J].Plast Sarg,1994,2(1):445．
[23]吴建明,吴包金,林子豪,等.四种耳廓支架材料与临床应用评估[J].中国实用美容外科杂志,2004,15(6):297-298.