中国修复重建外科杂志

中国修复重建外科杂志

三维立体力学平衡理念在全耳再造软骨支架构建中的应用

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目的 探讨全耳再造术中将三维立体力学平衡理念用于软骨支架构建的临床经验及疗效。 方法 2015 年 6 月—2017 年 6 月,收治 97 例(102 侧)小耳畸形患者应用组织扩张器法行全耳再造。男 43 例,女 54 例;年龄 7~45 岁,平均 14 岁。单侧小耳畸形 92 例,左侧 45 例、右侧 47 例;双侧 5 例。先天性 89 例,继发性 7 例。根据小耳畸形分型标准:Ⅱ型 21 例,Ⅲ型 67 型,Ⅳ型 9 例。一期植入组织扩张器。二期利用自体软骨构建耳支架,并切取皮瓣包裹;按照三维立体力学平衡理念,耳支架以支架底座、耳轮与对耳轮下脚的交汇处、耳轮缘为支撑点,形成稳定三角形结构。三期修整再造耳。 结果 患者均顺利完成三期手术。术后切口均Ⅰ期愈合;术后早期无感染、皮下积液和积血出现,皮瓣、皮片及耳支架完全成活。患者均获随访,随访时间 5~17 个月,平均 11.3 个月;61 例(64 侧)随访时间超过 12 个月。再造耳支架挺立,耳轮廓及各亚单位结构清晰,再造耳感觉定位清楚,双侧耳的位置、形态、大小和高度基本对称。3 例患者耳后乳突区瘢痕增生,经注射抗瘢痕药物后缓解。随访期间无软骨支架外露、吸收或结构变形等并发症发生。 结论 三维立体力学平衡理念用于全耳再造术中软骨支架构建,所需软骨量相对少,支架稳定可靠抗压能力强,能获得更好的耳再造外形效果。

Objective To summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction. Methods Between June 2015 and June 2017, ninety-seven microtia patients (102 sides) were treated with total ear reconstruction using tissue expanders. The patients include 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 7 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which covered by enlarged flap. According to the concept of three-dimensional mechanical balance, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation. Results All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) andfollow-up time exceeded 12 months in 61 cases (64 sides). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period. Conclusion Application of three-dimensional mechanical equilibrium concept in cartilage construction can reduce the dosage of costal cartilage, achieve more stable scaffold and acquire better aesthetic outcomes.

关键词: 小耳畸形; 耳廓再造; 软骨支架; 力学平衡

Key words: Microtia; auricular reconstruction; cartilage scaffold; mechanical equilibrium

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