摘要
目的比较耳颞区不同带蒂筋膜瓣在耳再造以及并发症防治中的临床应用及效果，以根据不同患者特征制定个体化耳再造方法并保留有充分的组织积极有效的防治并发症。方法对本科2004-2009年的56例小耳畸形或继发性耳廓缺损的患者，根据不同患者耳后无发区皮肤的面积和性质以及健侧耳廓的大小，参照耳颞区的血供构筑特征设计不同的带血管蒂筋膜瓣，用扩张或非扩张的方法包裹耳支架行耳再造，并在术后出现并发症时用预留的筋膜瓣行再造耳的修复；而在2003年以前(2000-2003)的患者，则随机采用不同的方法行耳再造。结果2000-2003年的16例耳再造患者，其中11例乳突区皮肤扩张法耳再造，3例耳后皮瓣一期再造，2例颞浅筋膜一期再造，总满意率56．25％；2004-2009年56例耳再造患者，其中39例乳突区皮肤扩张法耳再造，9例耳后皮瓣一期再造，8例颞浅筋膜一期再造，总满意率89．29％。结论在乳突区皮肤充足或者可以采用扩张器方法扩张乳突区皮肤的情况下，选择以肋软骨为支架乳突筋膜瓣包埋法行耳再造，而在乳突区皮肤筋膜条件受限或者不愿意用自体肋软骨的患者可以考虑用颞浅筋膜瓣包裹Medpor支架的方法，否则该方法一般不作为首先。
Objective Design individual auricular reconstruction method according to patients' different characteristics and conserve sufficient tissues to prevent and treat complications by comparing the clinical application and efficacy of different auricotemperal pedicle fascial flap. Method There were 56 cases of congenital microtia and secondary auricular defect patients in our department during 2004-2009. According to the area and texture of retroauricular unhaired skin and the size of opposite ear, we performed the auricular reconstruction by designing different pedicle fascial flaps depending on the auricotemperal blood supply, with or without expanded skin wrapped. We repaired the reconstituted auricular complication by the remained fascial flap. While the different random operation methods were performed to the patients during 2000-2003. Result For the 16 patients in 2000-2003, there were 11 patients with auricular reconstruction using expanded mastoid skin, 3 patients with one-stage auricular reconstruction using retroauricular skin flap and 2 patients with one-stage auricular reconstruction using temperal fascial flap. The total satisfactory rates were 56.25%. While for the 56 patients in 2004-2009,there were 39 patients with auricular reconstruction using mastoid expanded skin, 9 patients with one-stage auricular reconstruction using retroauricular skin flap and 8 patients with one-stage auricular reconstruction using temperal fascial flap. The total satisfactory rates were 89.29%. Conclusion For the patients with sufficient mastoid skin and who will choice the mastoid skin expanding method, the auricular reconstruction with costal cartilage wrapped by retroauricular fascial flap is preferred. While for the patients with insufficient mastoid skin or who won't chose the costal cartilage method, the auricular reconstruction with Medpor framework wrapped by temperal fascial flap is preferred, which is not usually as the first choice.
引文
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3. Park C, William C, Lineaweaver, et al. Arterial Supply of the Anterior Ear. Plast Reconstr Surg, 1992, 90(1): 38-44.
4. Ruyao Song, Yeguang Song, Keming Qi, et al. The superior Auricular Artery and Retroauricular Arterial Island Flaps. Plast Reconstr Surg. 1996, 98(4): 657-667.
5．杨大平，韩雪峰，郭铁芳，等．耳后皮瓣血管的显微外科解剖学基础．中国临床解剖杂志，2002，20(3)：166-168．
6. Park C et al. A new Arterial Flap from the postauricular Surface: Its Anatomic Basis and Clinical Applicafion. Plast Reconstr Surg, 1988, 82(3): 498-504.
7. Park C. Tai Suk Roh. Anatomy and embryology of the exteral ear and their clinical correlation. Clin Plastic Surg, 2002, 29: 455-474.
8. PS Kolhe, AG Leonard. The posterior auricular flap: anatomical studies. Br J Plast Surg, 1987, 40: 562-569.
9．晋培红，许枫，张如鸿，等．耳后动脉在乳突区分支的解剖学研究．组织工程与重建外科杂志，2008，4(4)：210-212．
10．丛蔚，王芳，李医丹，等．耳后动脉的解剖学观测．大连医科大学学报．2001，23(3)： 181-182．
11. Kobayashi S, Nagase Ohmofi K. Colour Doppler flow imaging of postauricular arteries and vein. Br J Plast Surg, 1997, 50: 172-175.
12. Park C, Lew DH, YOO WM. An analysis of 123 temporoparietal fascial flap: anatomic and clinical considerations in total, auricular reconstruction. Plast Reconstr Surg, 1999, 104(5): 1295-1306.
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15. Washio H. Retroauricular temporal flap. Plast Reconstr Surg, 1969, 43: 162.
16. Park C, William C, Lineaweaver, et al. Arterial Supply of the Anterior Ear. Plast Reconstr Surg, 1992, 90(1): 38-44.
17. Tanzer R. C. Microtia: A long-term follow-up of 44 reconstructed auricles. Plast Reconstr Surg, 1978, 61(1): 161-166.
18. Brent B. The correction of microtia with autogenous cartelage grafts: The classic deformity. Plast Reconstr Surg. 1980, 66(1): 1-12.
19. Satoru Nagata: Modification of the Stages in Total Reconstruction of the Auricle. Plast Reconstr Surg. 1994, 93(2): 221-266.
20. Avelar JM. Microtia.. total reconstruction of the auricle in one stage operation[J]. Br Plast Surg, 1981, 32(2): 224.
21．宋儒耀，陈宗基，岳纪良，等．一次手术完成的全耳廓再造．中国医学科学院整形外科医院学报，1981，(1)：9-11．
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24. Chul Park: Subfascial Expansion and Expanded Two-Flap Method for Microtia Reconstruction. Plast Reconstr Surg, 2000, 106(4): 1473-1487.
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