Department of Plastic and Cosmetic Surgery, Affiliated Hospital of Medical Collage, Qingdao University, Qingdao, China.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1448-53. doi: 10.1016/j.bjps.2011.06.025. Epub 2011 Jul 20.
The authors propose here a new strategy to obtain exceedingly expanded retroauricular mastoid skin for sufficient coverage of the three-dimensional autogenous costal cartilage framework generally used in auricular reconstruction surgery. From February 2000 to September 2009, 42 microtia reconstructions were performed using this new strategy.
Auricular reconstruction was performed in three surgical stages. In the first stage, a 50-ml kidney-shaped expander was inserted subcutaneously in the retroauricular mastoid region. From 5 to 8 ml saline was then injected into the expander every 4 days until the final volume of the expander reached 100-120 ml. In the second stage, we divided the expanded mastoid skin into a superior two-third region (flap A) and an inferior one-third region (flap B, rotation flap). Autogenous costal cartilage framework was then enveloped by these expanded flaps. Tragus construction and conchal excavation was performed in the third stage.
All patients were followed up from 6 months to 4 years after reconstruction. A total of 36 cases reported to be satisfied with the appearance of good shape, accurate size, right orientation, and duplication of well-detailed structures. Further revision was requested by six of the total. Complications in this series includes one case of haematoma, two cases of partial evection of the expanded skin and two cases of partial skin necrosis of the helix. All the complications were treated appropriately.
Exceeding expansion can provide sufficient retroauricular non-hair-bearing skin tissues for draping the auricular cartilage framework. Skin grafts and retroauricular fascial flap are not needed any more. Patients are usually satisfied with their reconstructive auricles as regards the size, location, projection, convolution, skin-colour matching, etc. Exceedingly expanded retroauricular flaps are the appropriate envelope for the auricular cartilage framework.
作者提出了一种新策略，用于获得极为扩张的耳后乳突皮瓣，以充分覆盖三维自体肋软骨框架，通常用于耳再造手术。从 2000 年 2 月至 2009 年 9 月，采用这种新策略进行了 42 例小耳畸形重建。
耳再造分三个手术阶段进行。第一阶段，在耳后乳突区域皮下植入一个 50ml 的肾形扩张器。每隔 4 天，向扩张器中注入 5 至 8ml 生理盐水，直至扩张器最终体积达到 100-120ml。第二阶段，我们将扩张的乳突皮瓣分为上三分之二区域（皮瓣 A）和下三分之一区域（皮瓣 B，旋转皮瓣）。然后，用这些扩张皮瓣包裹自体肋软骨框架。第三阶段进行耳屏再造和耳甲腔挖掘。
所有患者均在重建后 6 个月至 4 年内进行随访。共有 36 例患者报告对外观满意，形状良好、尺寸准确、方向正确，细微结构复制良好。其中 6 例患者要求进一步修正。该系列的并发症包括 1 例血肿、2 例扩张皮瓣部分外展和 2 例螺旋部部分皮肤坏死。所有并发症均得到妥善处理。
过度扩张可提供充足的耳后无毛皮肤组织，用于包裹耳廓软骨框架。不再需要皮片和耳后筋膜瓣。患者通常对重建耳廓的大小、位置、突出度、卷曲度、肤色匹配等方面感到满意。过度扩张的耳后皮瓣是耳廓软骨框架的合适包裹物。
