耳后乳突区全扩张法耳郭再造术的临床应用
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摘要
目的探讨皮肤扩张器结合自体肋软骨耳郭支架在耳郭再造中的应用效果。方法一期手术选择50 ml肾形扩张器埋置于残耳后乳突区皮下层次,注水总量约为60 ml。注水完毕后维持扩张2周。二期手术通过胸部小切口采集肋软骨,雕刻形成三维耳郭支架,将扩张器取出后通过负压吸引完整包裹耳郭支架。结果本组小耳畸形患者共17例,均完成50 ml肾形扩张器埋置。扩张器注水时间为28～35 d,注水量为60～65 ml。扩张器维持扩张时间为12～16 d,维持扩张完毕,可见扩张皮肤质薄、血管丰富。再造耳郭形态逼真、立体感强,经长期随访支架稳定,无变形和吸收发生。结论全扩张法耳郭再造操作简单、并发症较少,形态逼真,值得临床推广应用。
Objective To explore the application efficacy of tissue expander combined with autologous costal cartilage framework in the reconstruction of the auricle. Methods In the first stage, a 50 ml kidney-shaped expander was inserted in the subcutaneous layer of the mastoid region behind the residual ear, and the total amount of injected water was about 60 ml. All patients rested for nearly 2 weeks after the water injection was completed. In the second stage, the costal cartilage was harvested through a minimal incision in the chest. A three-dimensional ear framework was sculptured. The auricle framework was inserted and covered with the expander flap through negative pressure suction after the expander was removed. Results From January 2016 to December 2017, 17 microtia patients were selected and50 ml kidney-shaped expanders were implanted in each patient. The period of water injection into the expanders was from 28 to 35 days,and the total volume was from 60 to 65 ml. The expansion was maintained for 12 to 16 days. After the expansion was completed, the dilated skin was obviously thin and the blood vessels were rich. The reconstructed auricle had a realistic shape with a strong sense of symmetry.The framework was stable and no deformation or absorption occurred after long-term follow-up. Conclusion Full-expansion auricular reconstruction without skin graft was simple, involved fewer complications and resulted in a realistic shape, making this procedure viable for clinical popularization and application.
Objective To explore the application efficacy of tissue expander combined with autologous costal cartilage framework in the reconstruction of the auricle. Methods In the first stage, a 50 ml kidney-shaped expander was inserted in the subcutaneous layer of the mastoid region behind the residual ear, and the total amount of injected water was about 60 ml. All patients rested for nearly 2 weeks after the water injection was completed. In the second stage, the costal cartilage was harvested through a minimal incision in the chest. A three-dimensional ear framework was sculptured. The auricle framework was inserted and covered with the expander flap through negative pressure suction after the expander was removed. Results From January 2016 to December 2017, 17 microtia patients were selected and50 ml kidney-shaped expanders were implanted in each patient. The period of water injection into the expanders was from 28 to 35 days,and the total volume was from 60 to 65 ml. The expansion was maintained for 12 to 16 days. After the expansion was completed, the dilated skin was obviously thin and the blood vessels were rich. The reconstructed auricle had a realistic shape with a strong sense of symmetry.The framework was stable and no deformation or absorption occurred after long-term follow-up. Conclusion Full-expansion auricular reconstruction without skin graft was simple, involved fewer complications and resulted in a realistic shape, making this procedure viable for clinical popularization and application.
引文
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[6]蒋海越,国冬军,潘博,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):389-390.
[7]张爱君,金培生,陶常波,等.全扩张法耳郭再造联合激光脱毛治疗小耳畸形的效果[J].中华医学美学美容杂志,2018,24(5):346-349.
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[9]欧杨雪,李秉航,李孔盈,等.数字化技术在先天性小耳畸形耳郭再造中的应用[J].中华医学美学美容杂志,2018,24(3):149-152.
[10]SORVILLO V,FIORAMONTI P,SCUDERI N.Ear reconstruction:Tridimensionality and deception[J].Plast Reconstr Surg Glob Open,2016,4(6):e749.
[11]YOTSUYANAGI T,YAMAUCHI M,YAMASHITA K,et al.Correction of lobule-type microtia:part 2:the stage of ear elevation[J].Plast Reconstr Surg Glob Open,2014,2(9):e208.
[2]MUSSI E,FURFERI R,VOLPE Y,et al.ear reconstruction simulation:from handcrafting to 3D printing[J].Bioengineering(Basel),2019 Feb 5.
[3]BRENT B.Auricular repair with autogenous rib cartilage grafts:two decades of experience with 600 cases[J].Plast Reconstr Surg,1992,90(3):355-374.
[4]ZHAOS,LI D,LIUZ,et al.Anthropometric growth study of the ear in a Chinese population[J].J Plast Reconstr Aesthet Surg,2018,71(4):518-523.
[5]赵延勇,潘博,蒋海越,等.小耳畸形“三期法”耳郭再造序列治疗的临床研究[J].中国美容整形外科杂志,2011,22(2):68-70.
[6]蒋海越,国冬军,潘博,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):389-390.
[7]张爱君,金培生,陶常波,等.全扩张法耳郭再造联合激光脱毛治疗小耳畸形的效果[J].中华医学美学美容杂志,2018,24(5):346-349.
[8]YANG M,JIANG H,ZHANG Y,et al.A new method using tissue expander makes auricular reconstruction easier[J].Clin Otolaryngol.2019 Feb 8.
[9]欧杨雪,李秉航,李孔盈,等.数字化技术在先天性小耳畸形耳郭再造中的应用[J].中华医学美学美容杂志,2018,24(3):149-152.
[10]SORVILLO V,FIORAMONTI P,SCUDERI N.Ear reconstruction:Tridimensionality and deception[J].Plast Reconstr Surg Glob Open,2016,4(6):e749.
[11]YOTSUYANAGI T,YAMAUCHI M,YAMASHITA K,et al.Correction of lobule-type microtia:part 2:the stage of ear elevation[J].Plast Reconstr Surg Glob Open,2014,2(9):e208.