Postauricular artery island flap for subtotal ear reconstruction: expanding flap versatility based on zones of regional perfusion.
Postauricular artery island flap for subtotal ear reconstruction: expanding flap versatility based on zones of regional perfusion.
复制标题
用于耳部次全重建的耳后动脉岛状皮瓣：基于局部灌注区扩大皮瓣的多功能性。
DOI：
10.1097/01.prs.0000305378.62947.7e
复制
发表时间：
2008
影响因子：
3.6
通讯作者：
Lewis,VictorL
中科院分区：
文献类型：
--
作者：
Reid,RussellR;Lee,MichaelJ;Lewis,VictorL
耳后动脉皮瓣是耳甲重建的主力。先前的报告 1-4 重点关注耳甲缺损直接后部或颅部的皮瓣。这种“短蒂”设计在严重创伤或莫氏切除中是不可能的，因为耳甲和耳后亚基均不存在。我们提出了一种用于耳甲置换的耳后动脉皮瓣的新颖设计，该皮瓣利用了该血管丰富的血管网络。一名患有右耳基底细胞癌的 68 岁男性接受了莫氏手术。患者表现出耳甲和对耳轮缺失以及螺旋缘部分缺失（图 1）。此外，耳朵正后方的颅面不存在，从而否定了“旋转门”或乳突组织的直接拉动（图1）。使用多普勒探头设计了 3.5×3 厘米的岛状皮瓣，其中包含耳后动脉的枕乳突分支（图 1，箭头）。招募乳突下方 5 mm 处的筋膜皮肤复合材料。明智地使用多普勒超声能够解剖上层皮瓣（图 1）。皮瓣在无张力的情况下转位 180 度。置入皮瓣并初步闭合供体部位后，将 0.0012 英寸的分层厚度的右大腿皮肤移植物应用于耳后莫氏缺损。立即随访显示皮瓣充血程度最小。长期随访显示，重建耳朵的轮廓和颜色匹配良好（图 2）。患者没有肿瘤复发，正在等待通过吸脂术进行皮瓣修复。
The postauricular artery flap is a workhorse for conchal reconstruction. Previous reports 1–4 have focused on flaps directly posterior, or cranial, to the conchal defect. Such “short pedicle” designs are precluded in severe trauma or Mohs’ excision, where both conchal and postauricular subunits are absent. We present a novel design of the postauricular artery flap for conchal replacement that exploits the rich vascular network of this vessel.A 68-year-old man with basal cell carcinoma of the right ear underwent Mohs’ surgery. The patient exhibited loss of the cymba conchae and the antihelix and partial loss of the helical rim (Fig. 1). In addition, the cranial surface directly behind the ear was absent, negating “revolving door” or direct pull-through of mastoid tissue (Fig. 1). A 3.5× 3-cm island flap was designed using a Doppler probe, incorporating the occipitomastoid branch of the postauricular artery (Fig. 1, arrow). A fasciocutaneous composite 5 mm inferior to the mastoid prominence was recruited. Judicious use of Doppler ultrasound enabled dissection of a superiorly based flap (Fig. 1). The flap was transposed 180 degrees without tension. After insetting of the flap and primary closure of the donor site, a 0.0012-inch split-thickness right thigh skin graft was applied to the retroauricular Mohs’ defect. Immediate follow-up displayed minimal flap congestion. Long-term follow-up revealed excellent contour and color match of the reconstructed ear (Fig. 2). The patient has had no tumor recurrence, and flap revision via liposuction is pending.