Zhang Gan-Lin, Zhang Jin-Ming, Liang Wei-Qiang, Chen Yu-Hong, Ji Chen-Yang
Department of Plastic and Cosmetic Surgery, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Int J Pediatr Otorhinolaryngol. 2012 Oct;76(10):1515-9. doi: 10.1016/j.ijporl.2012.07.006. Epub 2012 Jul 24.
To present our clinical experience in using two skin soft-tissue expanders implanted superposingly in the mastoid region and Medpor ear framework for congenital microtia reconstruction.
The process of our technique is divided into three stages. In the first surgical stage, a 50 cm(3) and 80 cm(3) kidney-shaped expander is implanted under the fatty layer in mastoid region. Overlay the big expander on the small one. After the first surgery stage they are inflated alternately. In the second surgical stage, we remove two skin soft-tissue expanders and fix the Medpor ear framework to the fascial tissue which is covered by the expanded skin flap wholly without application of fascial flap. In the third stage, we perform the transposition of the auricular lobule to the designated position, construction of the tragus and refinement the new reconstructed ear. From January 2009 to December 2010, 27 patients were treated by this method of total ear reconstruction.
27 patients acquired symmetrical, subtle contour, prominent reconstructed auricles. The new reconstructed ear had a good contour and its skin color and texture were nearly the same as the normal surrounding skin. The postauricular sulcus was stable and satisfactory. The postoperative follow-up time ranged from 1 to 3 years. The expanded skin flap took well without necrosis. Exposure of the skin expander occurred in 2 patients (7.4%). The Medpor ear framework was extrused in one patient (3.7%). In addition, the hematoma was observed in 3 patients (11.1%). No other severe complications happened.
Overlying implantation of two skin-soft skin expanders solves the problem of insufficient amount of the skin flap, avoids postauricular skin grafting, simplifies the surgical procedure and shortens the operation time significantly.
介绍我们在乳突区叠加植入两个皮肤软组织扩张器并联合Medpor耳支架进行先天性小耳畸形再造的临床经验。
我们的技术过程分为三个阶段。在第一手术阶段，将一个50立方厘米和一个80立方厘米的肾形扩张器植入乳突区脂肪层下，大扩张器覆盖在小扩张器之上。第一次手术后阶段，交替对它们进行注水扩张。在第二手术阶段，取出两个皮肤软组织扩张器，将Medpor耳支架固定于完全被扩张皮瓣覆盖的筋膜组织上，不应用筋膜瓣。在第三阶段，将耳垂转移至指定位置，构建耳屏并对新再造耳进行精细化处理。2009年1月至2010年12月，27例患者采用此方法进行全耳再造治疗。
27例患者获得了对称、轮廓细腻、突出的再造耳廓。新再造耳轮廓良好，其皮肤颜色和质地与周围正常皮肤几乎相同。耳后沟稳定且令人满意。术后随访时间为1至3年。扩张皮瓣成活良好，无坏死。2例患者（7.4%）出现皮肤扩张器外露。1例患者（3.7%）出现Medpor耳支架外露。此外，3例患者（11.1%）出现血肿。未发生其他严重并发症。
两个皮肤软组织扩张器叠加植入解决了皮瓣量不足的问题，避免了耳后植皮，简化了手术操作，显著缩短了手术时间。
