李凡 曾黎 刘朝东

[摘要]目的：探究自體肋软骨联合膨体材料在耳廓再造中的应用及术后外露的修补方法。方法：选取2016年9月-2018年9月74例需进行耳廓再造患者作为研究对象，按照随机数字表法分为两组，各37例，对照组患者仅使用自体肋软骨，观察组患者使用自体肋软骨联合膨体材料进行耳廓再造。耳廓再造术采用改良的Nagata二期法完成。比较两组患者手术效果评价及术后外露的发生率，分析术后外露的原因及修补方法。结果：与对照组比较，观察组患者满意率较高、不满意率较低，且术后外露发生率较低，差异均具有统计学意义（P<0.05）。术后外露原因：①伤口愈合不良，导致软骨外露及感染;②筋膜瓣及耳前皮瓣未固定于软骨支架上，筋膜瓣与皮瓣交界处伤口裂开;③皮片存活欠佳。外露修补方法：感染时，立即行清创术，清除脓液，将肋软骨坏死组织切除，后期行修复术。肋软骨坏死较少，将筋膜瓣固定于软组织创缘，覆盖外露支架，再移植皮片修复。肋软骨坏死较多，应再次取肋软骨。结论：自体肋软骨联合膨体材料应用于耳廓再造中疗效较好，术后外露发生率低;采用合适的修补方法，可改善术后外露患者预后。

[关键词]先天性小耳畸形;自体肋软骨;膨体;耳廓再造术;支架外露

[中图分类号]R764.7    [文献标志码]A    [文章编号]1008-6455（2021）06-0056-04

Application of Autologous Costal Cartilage Combined with Expanded Material in Auricle Reconstruction and Postoperative Exposure Repair Method

LI Fan，ZENG Li，LIU Chao-dong

（Department of Burn Plastic and Cosmetic Surgery，People's Hospital of Guang'an City，Guang'an 638000，Sichuan，China）

Abstract： Objective  To investigate the application of autologous costal cartilage combined with expanded materials in auricle reconstruction and postoperative exposure repair methods. Methods  From September 2016 to September 2018， 74 patients with auricular reconstruction were selected as subjects. According to the random number table method， 37 patients were divided into two groups. The control group only used autologous costal cartilage. The observation group used autologous costal cartilage combined with expanded material for auricle reconstruction. Auricle reconstruction was performed using the modified Nagata Phase II method. The evaluation of surgical results and the incidence of postoperative exposure were compared between the two groups， and the causes and repair methods of postoperative exposure were analyzed. Results  Compared with the control group， the patients in the observation group had higher satisfaction rate and lower dissatisfaction rate， and the differences were statistically significant （P<0.05）. Compared with the control group， the incidence of postoperative exposure was lower in the observation group （P<0.05）. Causes of postoperative exposure： poor wound healing， resulting in cartilage exposure and infection， fascia flap and anterior skin flap were not fixed on the cartilage scaffold， the wound was ruptured at the junction of the fascial flap and the flap， the skin survived poorly. Exposed repair method： Immediately during infection， debridement is performed to remove pus， the costal cartilage necrosis tissue is removed， and the repair is performed later. The costal cartilage is less necrotic. The fascia flap is fixed on the soft tissue wound edge， covering the exposed stent， and then the graft is repaired. The costal cartilage is more necrotic， and the costal cartilage should be taken again. Conclusion  The autologous costal cartilage combined with expanded material has a good effect on auricle reconstruction， and the incidence of postoperative exposure is low. Appropriate repair methods can improve the prognosis of patients exposed to surgery.

Key words： congenital microtia; autologous costal cartilage; expanded; auricle reconstruction; stent exposure

先天性小耳畸形是耳面部的常见畸形之一，与第一、二鳃弓、神经嵴细胞、第一烟弓发育不良相关，临床表现为耳廓软骨结构畸形、外耳道闭锁或狭窄、中耳畸形以及相关器官畸形等[1]。不仅给患者家庭造成极大压力，还给患者自身造成严重的心理影响[2]。在世界不同区域先天性小耳畸形发病率差异较大，中国地区发病率约为3.06/10 000[3-4]。目前，先天性小耳畸形发病机制及原因仍不清楚，较多研究学者认为是胚胎发育期，在物理射线、化学物质及病毒感染等因素的作用下引起基因突变，导致耳廓软骨发育畸形[5-6]。目前，临床主要采用外科手术治疗，治疗方式有三种，包括耳廓再造、义耳、基因工程耳，其中耳廓再造术是最常用的治疗方式。……