摘要
目的探讨Medpor和刃厚头皮片在先天性小耳畸形Nagata法耳廓再造耳颅沟成形中的应用方法及疗效。方法参照Nagata二期法耳廓再造程序完成一期手术，即肋软骨耳廓支架成型和移植，一期术后6个月后行二期耳颅沟成形：于患侧颞枕部获取与再造耳上部皮肤连续的刃厚皮片，翻起皮片，在再造耳外耳轮外5mm切开达皮下层，向耳甲腔方向分离并掀起软骨支架；以c形Medpor支架支撑于再造耳支架后方，再造耳支架背面和Medpor表面行带颞浅血管的颞浅筋膜瓣覆盖，最后将刃厚头皮片覆盖于筋膜瓣表面缝合固定，湿纱卷加压固定。结果2010年7月至2012年8月，于临床应用20例22侧，1例二期术后发现颡浅筋膜瓣部分坏死、支架外露，采用耳后筋膜瓣覆盖及刃厚头皮片移植修复。其余患者均顺利完成二期手术。随访时间为6～18个月，平均13个月，20例22只再造耳术后耳颅沟形状均满意。结论应用刃厚头皮片和Medpor材料可以获得稳定满意的耳颅沟，且既可避免切取全厚或中厚皮片在供区所遗留的明显瘢痕，又可减少因切取过多的肋软骨对胸廓的创伤。
Objective To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method. Methods The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the eranioauricular sulcus. Split-thickness skin was taken from temporal and aceipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface. Results From July 2010 to August 2012, 20 cases （22 ears） were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months （average, 13 months）. Conclusions The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2014年第2期84-88,共5页
Chinese Journal of Plastic Surgery
基金
福建省卫生系统中青年骨干人才培养项目（2013-ZQN-JC-19）
国家临床重点专科建设项目经费资助
