Combining Scalp Tissue Expansion With Porous Polyethylene Total Ear Reconstruction in Burned Patients
Combining Scalp Tissue Expansion With Porous Polyethylene Total Ear Reconstruction in Burned Patients
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DOI：
10.1097/sap.0b013e3181a13da5
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发表时间：
2010-02
影响因子：
1.5
通讯作者：
D. Driscoll;Jeffrey H. Lee
中科院分区：
文献类型：
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作者：
D. Driscoll;Jeffrey H. Lee
烧伤的耳朵重建仍然是整形外科最困难的领域之一。当用肋软骨移植物重建时，需要一个上级的结果来证明供区的发病率。最近，更多的研究评价了多孔聚乙烯耳再造在小耳和烧伤。烧伤导致耳廓完全丧失是罕见的，通常伴有明显的脱发。组织扩张术是治疗头皮烧伤后脱发的一种有效方法。深度烧伤的皮肤上经常有密集的疤痕，以至于肋软骨移植会产生一个难以形容的疤痕块，与自然耳朵几乎没有相似之处。该小型系列综述描述了3例多孔聚乙烯和全耳重建结合组织扩张重建治疗烧伤脱发的病例。这种方法可以作为一种非常有效的组合程序在严重烧伤的病人没有额外的并发症的肋软骨移植。这是第一次描述这种组合程序。在最初的程序，一个大的组织扩张器是放置在头发轴承头皮下的帽状腱膜下平面。在移除组织扩张器和切除脱发时，颞顶筋膜瓣被抬高。秃发切除术的切口易于在外耳道后剥离。然后将多孔聚乙烯结构向后放置并用颞顶筋膜瓣包裹。同时重建发际线。所描述的技术充分利用了颞顶筋膜瓣，否则，可能会被切除或脱发切除术损伤。它还允许脱发重建，并一次完成2个重建目标，很少或没有供体部位发病率。
Burned ear reconstruction remains one of the most difficult areas of plastic surgery. A superior result is needed to justify the donor site morbidity when reconstructing with a costochondral graft. Recently, more studies have evaluated porous polyethylene ear reconstruction in microtia and in burns. A total loss of the pinna from burns is rare and often associated with significant alopecia. Tissue expansion is an excellent means of reconstructing burned scalp alopecia. Deeply burned skin is often so densely scarred that a costochondral graft would produce a nondescript scarred mass with little resemblance to the native ear. This mini series overview describes 3 cases of porous polyethylene and total ear reconstructions done in conjunction with tissue expansion reconstruction for burn alopecia. This method can be used as a very efficient combination of procedures in a severely burned patient without the additional morbidity of costochondral grafting.This is the first description of this combination of procedures. At the initial procedure, a large tissue expander is placed beneath the hair-bearing scalp in a subgaleal plane. At the time of tissue expander removal and alopecia resection, a temporoparietal fascia flap is elevated. The incisions for alopecia resection allow easy dissection behind the external auditory meatus. The porous polyethylene construct is then placed posteriorly and wrapped with the temporoparietal fascial flap. The hairline is reconstructed simultaneously. The technique described makes full use of the temporoparietal fascial flap that may, otherwise, be resected or injured with the alopecia resection. It also allows alopecia reconstruction and accomplishes 2 reconstructive goals at once with little or no donor site morbidity.