Brent B
El Camino Hospital, Mountain View, California, USA.
Plast Reconstr Surg. 1999 Aug;104(2):319-34; discussion 335-8. doi: 10.1097/00006534-199908000-00001.
Through the author's experience with 1200 cases during a 25-year period, this article presents technical improvements in ear reconstruction and proposes and discusses possible directions for further technical advancement. This article presents the rationale for the author's current methods of managing total ear repair. Throughout the article, the author stresses and demonstrates cartilage-sparing techniques that are designed to minimize the amount of cartilage used in a repair to preserve maximum chest wall integrity. This article also presents the latest method of framework fabrication, showing differences in construction between younger and older patients; a new method that constructs a tragus as an integral part of the framework; a method that maintains ear projection with a scalp-banked cartilage wedge; and a method that solves the always frustrating low hairline by presurgical laser treatment. In addition, the concept of creating autogenous frameworks by tissue engineering is pursued and discussed in practical clinical terms. A survey of 1000 microtia patients indicates that surgically constructed ears remain durable, withstand trauma well, and provide consistent emotional relief and psychological benefits through the repair.
通过作者在25年期间对1200例病例的经验，本文介绍了耳再造的技术改进，并提出并讨论了进一步技术进步的可能方向。本文阐述了作者目前全耳修复方法的基本原理。在整篇文章中，作者强调并展示了保留软骨的技术，这些技术旨在尽量减少修复中使用的软骨量，以保持胸壁的最大完整性。本文还介绍了框架制作的最新方法，展示了年轻患者和老年患者在构建上的差异；一种将耳屏构建为框架组成部分的新方法；一种用头皮储存的软骨楔维持耳部突出的方法；以及一种通过术前激光治疗解决一直令人沮丧的低发际线问题的方法。此外，还从实际临床角度探讨了通过组织工程创建自体框架的概念。对1000例小耳症患者的调查表明，手术构建的耳朵仍然耐用，能很好地承受创伤，并通过修复持续提供情感缓解和心理益处。
