Park C
Department of Plastic Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Seoul, Korea.
Plast Reconstr Surg. 2000 Dec;106(7):1473-87. doi: 10.1097/00006534-200012000-00005.
This article presents an improved two-flap method for microtia reconstruction. In the first stage of this method, a tissue expander is inserted in the mastoid region through a subfascial pocket, after which the overlying fascia and skin are expanded simultaneously with saline infusion for about 5 months. In the second stage, the expanded fascial and skin layers are split and prepared as anteriorly based skin and fascial flaps defined by their vascularity. An erect, three-dimensional, contour-accentuated ear framework fabricated with autogenous rib cartilage is inserted between the two flaps. The anteroauricular surface of the framework is draped with the thin, expanded skin, and the postauricular surface is draped with the thin, expanded fascia and overlying grafted skin. In the third stage, remnant auricular cartilage is removed and the crus helicis, tragus, intertragic notch, conchal floor, and a hollow mimicking the external auditory meatus are shaped. In this study, 146 microtias were reconstructed consecutively using the improved two-flap method. The final results were promising--major complications were minimal and most patients showed consistently favorable aesthetic results. This method married a two-flap procedure with a gradual tissue expansion, conveniently exploiting the advantages of both methods, but without the disadvantages.
本文介绍了一种改良的双瓣法耳廓再造术。在该方法的第一阶段，通过筋膜下袋在乳突区植入组织扩张器，之后通过注入生理盐水同时扩张覆盖的筋膜和皮肤约5个月。在第二阶段，将扩张的筋膜层和皮肤层分开，并根据其血供制备以蒂在前的皮肤和筋膜瓣。将用自体肋软骨制作的直立、三维、轮廓突出的耳支架插入两个皮瓣之间。支架的耳前表面覆盖薄的扩张皮肤，耳后表面覆盖薄的扩张筋膜和覆盖的移植皮肤。在第三阶段，切除残余的耳廓软骨，并塑造耳轮脚、耳屏、耳屏间切迹、耳甲腔底部以及模拟外耳道的凹陷。在本研究中，连续使用改良双瓣法对146例小耳畸形进行了再造。最终结果令人满意——主要并发症极少，大多数患者均呈现出持续良好的美学效果。该方法将双瓣手术与组织逐渐扩张相结合，方便地利用了两种方法的优点，而无其缺点。
