康春雨 税文祥 陈倩 杨跃 李博强 章庆国

[摘要]目的：探讨应用大容量皮肤软组织扩张器，扩张患侧耳颞部及乳突区皮肤，并与自体肋软骨耳支架雕刻移植相结合，治疗先天性小耳畸形的修复效果。方法：手术分两期完成，一期行皮肤软组织扩张器置入;二期采用自体肋软骨雕刻成形耳支架移植的方法行耳再造。结果：本组先天性小耳畸形患者共156例（165侧），经6个月～6年随访观察，絕大多数（84.6%）患者对再造耳外观满意，再造耳轮廓逼真，皮瓣色泽、位置、形态和大小与对侧基本一致;有4例（侧）因皮肤扩张期内扩张器外露，改用扩张皮瓣及耳后筋膜瓣包裹耳支架加耳后植皮的方法进行耳再造;2例（侧）因感染改用颞浅筋膜瓣覆盖耳支架加游离植皮进行耳再造。结论：应用耳颞部及乳突区皮肤软组织大容量扩张，结合自体肋软骨支架雕刻移植的外耳再造方法，再造耳形态逼真，经随访皮瓣挛缩不明显，是治疗先天性小耳畸形的适宜方法之一。

[关键词]小耳症;耳再造;皮肤扩张;自体肋软骨;先天畸形

[中图分类号]R764.7+1    [文献标志码]A    [文章编号]1008-6455（2021）01-0001-03

Clinical Study of Large Capacity Skin Soft Tissue Expander Combined with Autologous Costal Cartilage Framework in the Treatment of Congenital Microtia

KANG Chun-yu1，SHUI Wen-xiang1，CHEN Qian1，YANG Yue1，LI Bo-qiang1，ZHANG Qing-guo2

（1.Department of Cosmetic Surgery，Bravou Aesthetic Plastic Hospital，Chengdu 610000，Sichuan，China;2.Department of Plastic Surgery 4，Plastic Surgery Hospital，Chinese Academy of Medical Sciences，Peking Union Medical College，Beijing 100144，China）

Abstract： Objective  This research aims to examine the repairing effect of the treatment of congenital microtia which adopted the large capacity of skin soft tissue expander， combined with autogenous costal cartilage framework transplantation. Methods  The operation was completed in two phases. First， the skin soft tissue expander is placed. In the second phase， the autologous costal cartilage framework was used for the reconstruction. Results  There were 156 cases （165 sides） with congenital microtia. The patients were followed up for 6 months to 6 years. Most of the patients（84.6%） were satisfied with the reconstituted ears. The color， position， shape and size of the flap were similar to those of the contralateral side. Four cases were reconstituted using expanded skin flap and retroauricular fascial flap parcel skin graft method due to expander exposed during skin expansion. Two cases were reconstituted using the temporoparietal fascial flap to cover the framework and free skin grafts because of infection. Conclusion  The results indicate that the reconstructed ear is realistic， and the skin flap contracture is not obvious. The expanded flap technique with large capacity of skin expander is one of suitable methods for the treatment of congenital microtia malformation.

Key words： microtia; auricular reconstruction; skin expansion; autogenous costal cartilage; congenital malformation

耳廓是包含精细结构的成对竖立的体表器官，在大约4cm×6cm的狭小空间内，包含有12～14个解剖结构。耳廓再造过程中，用薄的皮肤覆盖具有精细凹凸结构的耳支架是获得良好外形再造耳的前提。同时，皮肤覆盖的是三维耳廓支架，保持这种三维结构的终身存在，防止耳支架被吸收，出现再造耳倒伏、塌陷等并发症，是耳再造过程中需要关注的重要问题。……