Total Auricular Reconstruction Using a Single Extended Postauricular Flap Without Skin Grafting in Two Stages: Experiences of 106 Cases
Total Auricular Reconstruction Using a Single Extended Postauricular Flap Without Skin Grafting in Two Stages: Experiences of 106 Cases
复制标题
单片延长耳后皮瓣二期不植皮全耳廓重建术106例体会
DOI：
10.1007/s00266-019-01459-6
复制
发表时间：
2020-04-01
影响因子：
2.4
通讯作者：
Zhang, Qingguo
中科院分区：
文献类型：
--
作者：
Chen, Qi;Zhang, Jiao;Zhang, Qingguo
背景耳廓筋膜瓣联合植皮是目前流行的全耳再造方法，但其可能导致瘢痕明显，颜色不匹配，尤其是在亚洲人群中。其他使用扩张的小腿皮瓣来避免植皮的方法通常需要三次或更多次手术，这增加了患者的痛苦。本研究旨在介绍一种改良的耳廓再造技术，采用单一扩张的耳廓皮瓣在两阶段手术中不需植皮。方法经术前评估后，将80 ml肾形扩张器植入乳突区作为一期手术。经过一段逐渐扩张期和2个月的休息时间，皮瓣达到了合适的大小和厚度。第二阶段，制作三层软骨支架，并通过残耳处的切口插入袋中，同时重建耳垂和耳屏。结果2013年9月至2017年10月，我院共选择106例小耳畸形患者应用该方法进行耳廓再造。随访6个月~ 4年。大部分患者（93.4%）对再造耳满意，特别是对颜色合适和疤痕不明显方面。3例发生扩张器外露或支架外露并发症，均获得满意效果。结论不需植皮的大面积扩张耳廓皮瓣是一种有效的耳廓再造方法，效果满意。它可以在不需要植皮的情况下重建一个精致的耳朵，并且只需要两个阶段的手术就可以完成。
Background Postauricular fascial flap with skin grafting is popular as a solution in total auricular reconstruction, which might result in visible scars and mismatched color, especially in Asian people. Other methods using an expanded postauricular flap to avoid skin grafting often require three or more operations, which increases suffering for patients. This work aims to introduce a modified technique for auricular reconstruction using a single expanded postauricular flap without skin grafting in a two-stage operation. Methods An 80-ml kidney-shaped expander was implanted in the mastoid area as the first-stage operation after preoperative evaluation. After a gradual expansion period and a 2-month rest time, the flap achieved the appropriate size and thickness. In the second stage, a three-layer cartilage framework was fabricated and inserted into the pocket through an incision at the remnant ear, and the earlobe and tragus were rebuilt simultaneously. Results From September 2013 to October 2017, 106 microtia patients were selected for auricular reconstruction applying this method in our hospital. Patients were followed up to 6 months to 4 years. Most of them (93.4%) were satisfied with the reconstructed ears, especially with respect to suitable color and invisible scars. Complications of expander exposure or framework exposure happened in three cases, and all of them finally got a satisfactory result. Conclusion A single large expanded postauricular flap without a skin graft is an effective and efficient technique for auricular reconstruction with satisfying results. It can reconstruct an exquisite ear without a skin graft and can be finished in only two stages of operations.