Using an expanded scalp flap without fascial flap harvest or skin grafting for total auricular reconstruction in hemifacial microsomia with low hairline
Using an expanded scalp flap without fascial flap harvest or skin grafting for total auricular reconstruction in hemifacial microsomia with low hairline
复制标题
使用扩张头皮瓣，不采集筋膜瓣或植皮，对低发际线的半侧面部短小症进行全耳廓重建
DOI：
10.1016/j.ijporl.2019.109726
复制
发表时间：
2020-01-01
影响因子：
1.5
通讯作者：
Zhang, Qingguo
中科院分区：
文献类型：
--
作者：
Chen, Qi;Wang, Bingqing;Zhang, Qingguo
背景：对于发际线极低的半面矮小症患者，全耳再造术是整形外科的一项艰巨挑战。在这项工作中，描述了一种全新的技术，使用Singer扩张的头皮瓣不植皮，结合强脉冲光疗法(IPLT)进行耳再造。方法：2015年1月至2019年4月，41例发际线低70-100%的半面部巨大儿(HFM)患者被纳入本研究。手术治疗分为3个阶段：1.扩张器置入和充气；2.扩张器取出、肋软骨支架制作和耳廓重建术；3.Tragus重建术和重建耳廓再造术。每45天进行一次IPLT，直到整个过程中局部变得无毛。第一个IPLT可以在所有操作之前执行，也可以在扩展期间执行。用M22系统，滤光片为695~1200 nm。结果：随访10个月至4年，90.2%的患者对手术效果满意，尤其是在瘢痕小、颜色自然匹配、再造耳轮廓清晰等方面。无严重并发症发生。扩张期开始IPLT的患者脱毛治疗次数较少(p<；0.05)。结论：单次扩张头皮瓣联合强脉冲光脱毛是治疗发际线极低的半侧面部巨大症的一种安全、有效、创伤小的方法，效果满意。建议在扩展期间对IPLD进行初始化。
Background: Total auricular reconstruction for hemifacial microsomia patients with extremely low hairline is a tough challenge in plastic surgery. In this work, a brand new technique using a singer expanded scalp flap without skin graft and combined with intense pulse light treatments (IPLT) for ear reconstruction is described in this special population.Methods: From January 2015 to April 2019, 41 hemifacial macrosomia (HFM) patients with 70-100% low hairline were enrolled in our study. Operative treatment was performed in 3 stages: 1. Expander insertion and inflation; 2. Expander removal, costal cartilage framework fabrication and auricular reconstruction; 3. Tragus reconstruction and reconstructed auricle refinement. Several IPLTs were performed every 45 days until local area become hairless during the whole course. The first IPLT could be executed either before all the operations or during the expansion period. The flap was treated with M22 system using a filter of 695-1200 nm. Follow up ranged from 10 months to 4 years.Results: During follow-up, 90.2% patients were surveyed as satisfied with the outcome, especially in the aspects of minimal scars, natural matched color and clear contour of the reconstructed ear. No serious complications happened. Patients starting the IPLT during the expansion period required less treatment times of depilation (p < 0.05).Conclusion: Auricular reconstruction using a single expanded scalp flap combined with intense pulse light depilation is a safe, effective and less invasive technique for hemifacial microsomia with extremely low hairline, and providing highly satisfying results. Initialing the IPLD during the expansion period is recommended.