组织工程与重建外科杂志 ›› 2014, Vol. 10 ›› Issue (3): 156-160.doi: 10.3969/j.issn.1673-0364.2014.03.009

• 论著 • 上一篇    下一篇

改良法肋软骨全耳廓再造术

李意源,张如鸿,张群,许志成,许枫,李大涛,孙楠,汪诚   

  1. 上海交通大学医学院附属第九人民医院整复外科
  • 发布日期:2020-07-23

Modifications in Autogenous Rib Cartilage Reconstruction of Microtia

LI Yiyuan,ZHANG Ruhong,ZHANG Qun,XU Zhicheng,XU Feng,LI Datao,SUN Nan,WANG Cheng   

  1. Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine;
  • Published:2020-07-23

摘要: 目的对二期法的肋软骨全耳廓再造术进行改进,以增强再造耳结构的自然性及稳定性。方法自2009起,对234例小耳畸形患者行全耳廓再造,并对肋软骨全耳廓再造法进行了系列改良,措施包括:①供区仅切取第6~8肋软骨;②根据肋软骨厚度不同,采取个性化雕刻;③耳屏对耳屏复合体下方以U型软骨块支撑;④Ⅰ期术后,对耳舟和耳甲腔进行负压管理;⑤Ⅱ期手术时使用特定形状的骨水泥支架进行支撑。结果术后患者均随访6个月以上,在耳廓的位置及三维形态、耳廓皮肤色泽、与健侧耳的对称性等方面多能达到满意效果,再造耳结构及颅耳沟的稳定性获得保证。本方法的术后并发症主要为颅耳角缩小,系由严重瘢痕增生与挛缩引起。结论对肋软骨全耳廓再造术的改良有效、实用,术后效果满意,但不易精确控制。

关键词: 先天性小耳畸形, 全耳廓再造术, 肋软骨, 改良

Abstract: Objective To introduce the modifications in autogenous rib cartilage reconstruction of microtia, so as to present more natural and stable morphology of the reconstructed ear. Methods From 2009, 234 cases of microtia were received modified total ear reconstruction by autogenous costal cartilage. Modifications of the two-staged surgery were as follows: Decreasing the needed rib cartilage into 6~8 in donor site;Different cartilage framework in different patient;Designing a U shape cartilage block to support the complex of tragus and antitragus; The negative suction management in the second stage surgery;Using specific bone cement in the second stage surgery for ear elevation. Results All the patients were followed up for more than 6 months, most reconstructed ears were satisfiable in symmetry and stability of the three dimensional morphology and the cranio-auricular angle. Skin color and texture were favorable as well. The most common complication was reduction of the projection angle of the constructed ear caused by hypertrophic scars and severe scar contractures. Conclusion These modifications in autogenous rib cartilage reconstruction of microtia are effective and practical. So far the results of ear reconstruction are satisfactory but not in complete control.

Key words: Congenital microtia, Total ear reconstruction, Autogenous costal cartilage, Modification

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