扩张皮瓣加筋膜瓣“两瓣法”在小耳畸形患者耳郭再造中的应用

doi:10.6040/j.issn.1673-3770.0.2019.238

摘要/Abstract

摘要： 目的探讨带蒂扩张皮瓣加带蒂筋膜瓣“两瓣法”在先天性小耳畸形患者耳郭再造中的应用及效果。方法总结2012年1月至2018年1月期间712例(756耳)先天性小耳畸形患者,全部采用“两瓣法”行耳郭再造。结果术后随访1~6年,712例(756耳),其中15例(15耳)术后出现钢丝外露,经及时处理,拆除钢丝后治愈;10例术后出现再造耳郭皮下血肿,经更换负压引流管,引流通畅后,血肿消失;3例因术后患者保护不当,再造耳郭受压、碰伤导致软骨支架外露,经局部皮肤拉拢缝合,带蒂筋膜瓣覆盖表面植皮,及时处理后治愈。全部病例最终效果均满意,再造耳郭的大小、形态、位置与健耳对称,再造耳郭皮肤颜色正常,耳郭软骨支架无外露及吸收,细微凹凸结构显示清晰。结论 “两瓣法”耳郭再造效果确切,术后并发症少,是先天性小耳畸形行耳郭再造较好的方法。

关键词: 两瓣法, 先天性小耳畸形, 耳郭再造

Abstract: Objective To discuss the application and effect of ear reconstruction with expanded skin flaps and fascial flaps(the two flaps method), in congenital microtia. Methods The study included 712 cases(756 ears)of congenital microtia from January 2012 to January 2018, all reconstructed with the two flaps method. Results All cases were followed-up for 1 to 6 years. Among them, 15 cases(15 ears)had steel wire exposure after the operation, which was resolved after removing the steel wire over time. Ten cases had subcutaneous hematoma of the reconstructed auricle after the operation, which disappeared after replacing the negative pressure drainage tube. Three cases had exposed cartilage scaffold due to improper protection of the reconstructed auricle, which was sutured by local skin and covered with pedicled fascia flaps. Patients were cured after timely treatment. The size, shape, and location of the reconstructed auricles were basically symmetrical with the healthy ears. The reconstructed auricle skin was normal in color, the auricle cartilage scaffold was not exposed or absorbed, and the fine concave and convex structure was clear. Conclusion The two flaps ear reconstruction is a better method for the treatment of congenital microtia because of its superior result and fewer complications.

Key words: Two flaps, Congenital microtia, Ear reconstruction

中图分类号:

R764.7

薄琳,刘新刚,刘玉红,苏法仁. 扩张皮瓣加筋膜瓣“两瓣法”在小耳畸形患者耳郭再造中的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 49-51.

BO Lin, LIU Xingang, LIU Yuhong, SU Faren. Application of expanded skin flaps and fascial flaps(the two flaps method)in ear reconstruction for patients with microtiag[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 49-51.

参考文献

[1] 苏法仁,丁静华,赵继臣,等.先天性小耳畸形外耳再造临床研究[J].武警医学,2007,18(4):278-281. doi:10.3969/j.issn.1004-3594.2007.04.012. SU Faren, DING Jinghua, ZHAO Jichen, et al.Ear reconstruction of congenital microtia[J]. Med J Chin PAP, 2007,18(4):278-281. doi:10.3969/j.issn.1004-3594.2007.04.012.
[2] 苏法仁,丁静华,薄琳,等.先天性小耳畸形的耳郭再造[J]. 中华耳科学杂志,2014, 12(1):90-92. doi:10.3969/j.issn.1672-2922.2014.01.022. SU Faren, DING Jinghua, BO Lin, et al. Auricle reconstruction of microtia[J]. Chinese Journal of Otology, 2014, 12(1):90-92. doi:10.3969/j.issn.1672-2922.2014.01.022.
[3] 苏法仁,刘玉红,薄琳,等.一种缝合装置在耳郭再造手术胸部切口缝合中的应用[J].中华耳科学杂志,2019,17(2):272-274. doi:10.3969/j.issn.1672-2922.2019.02.026. SU Faren, LIU Yuhong, BO Lin, et al. A Suture Device for Thoracic Donor Site Incision closure in Auricular Reconstruction[J]. Chinese Journal of Otology, 2019,17(2):272-274. doi:10.3969/j.issn.1672-2922.2019.02.026.
[4] 苏法仁.一种外耳再造手术用缝合装置:201520183101.7[P].2015-08-26.
[5] 苏法仁,薄琳,丁静华,等.外伤后耳郭缺损的修复[J].山东大学耳鼻喉眼学报,2013,27(1):33-35. doi:10.6040/j.issn.1673-3770.0.2012.178. SU Faren, BO Lin,DING Jinghua, et al. Repair of traumatic auricle defect[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2013,27(1):33-35. doi:10.6040/j.issn.1673-3770.0.2012.178.
[6] 苏法仁,丁静华,刘玉红.苏氏定位法在小耳畸形患者耳郭再造中的应用[J]. 中华耳科学杂志,2016,14(4):551-553. doi:10.3969/j.issn.1672-2922.2016.04.025. SU Faren, DING Jinghua, LIU yuhong. Application of Sus localization method for auricular reconstruction in patients with microtia[J]. Chinese Journal of Otology, 2016,14(4):551-553. doi:10.3969/j.issn.1672-2922.2016.04.025.
[7] 薄琳,苏法仁,丁静华. 负压引流技术在外耳再造中的临床应用[J].山东大学耳鼻喉眼学报,2011,25(6):43-45. BO Lin,SU Faren, DING Jinghua.Clinical application of negative pressure drainage in ear reconstruction[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2011,25(6):43-45.
[8] 苏法仁.一种用于皮肤扩张法耳郭再造的持续负压引流装置:ZL201720115820.4 [P].2018-05-01.
[9] Brent B. Teehnicat advanceis in ear reconstruction with autogenous rib cartilage grafts:Personal experienee with 1200 cases[J].Plast Reconstr Surg,1999,104(2):319-334.
[10] Hata Y, Hosokawa K, Yano K, et al. Correction of eongenital microtia using the tussue expander[J]. Plast Reconstr Surg, 1989, 84(5):741-753.
[11] Park C. Subfaseial expansion and expanded two-flap method for microtia reconstruction[J].Plast Reconstr Surg,2000,106(7):1473-1487.
[12] 苏法仁,丁静华,薄琳.皮肤软组织扩张术在外耳再造中的应用[J].中国耳鼻咽喉头颈外科,2009,16(9):500-502. SU Faren, DING Jinghua, BO Lin. Clinical application of skin soft tissue expansion for auricular reconstruction[J].Chin Arch Otolaryngol Head Neck Surg, 2009,16(9):500-502.
[13] 苏法仁,薄琳,丁静华,等.烧伤后耳郭缺损的修复[J]. 中华耳科学杂志,2011,9(1):1-3. doi:10.3969/j.issn.1672-2922.2011.01.001. SU Faren, BO Lin, DING Jinghua, et al. Repairing auricle defect from burn injury[J]. Chinese Journal of Otology, 2011,9(1):1-3. doi:10.3969/j.issn.1672-2922.2011.01.001.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed