Zhou Xu, Zhang Qingguo, Liu Tun, Han Xuefeng, Xie Yangchun, Wang Yue, Cheng Kun, Tian Meng, Yang Qiao
Department of Plastic and Reconstructive Surgery, Beijing Plastic Surgery Hospital, Peking Union Medical College, Beijing, PR China.
J Craniofac Surg. 2012 Sep;23(5):1296-300. doi: 10.1097/SCS.0b013e3182564a49.
Ear framework fabrication with autologous costal cartilage is considered to be one of the important factors for successful auricular reconstruction. Congenital microtia in adults has many particular physiological characteristics different from that in children. The authors report an effective ear framework-fabricating technique in congenital microtia in adults. Technical points regarding the reduction of the amount of costal cartilage harvested and the increase of the flexibility of the cartilage are discussed.
One hundred three adult patients diagnosed with unilateral congenital microtia were treated with skin expansion method for a 2-year period. The ear framework was fabricated using splicing method. The seventh costal cartilage was harvested from 74 patients (with 35 lobular and 39 conchal types) for fabricating the ear framework. For the remaining 29 patients (with 19 lobular and 10 conchal types), both the seventh and eighth cartilages were harvested for fabrication.
Eighty-four patients (81.55%) were satisfied with the outcome of the reconstructed ear. Fourteen patients (13.60%) found the result acceptable, whereas 5 patients (4.85%) found the result unacceptable. Six patients (5.82%) showed different levels of absorption and cartilage deformation. Five patients (4.85%) were found to have the steel wire extruded. There were no postoperative complications related to chest wall deformity or that affected normal physical function. Ninety-three patients (90.29%) had good recovery of the chest wall. Ten patients (9.71%) had increased chest scar.
Compared with traditional methods, the technique proposed is a simple approach that can effectively treat adult patients with congenital microtia. This kind of cartilage-harvesting and ear framework-fabricating technique is an appropriate management choice for congenital microtia in adults.
采用自体肋软骨制作耳支架被认为是耳廓再造成功的重要因素之一。成人先天性小耳畸形具有许多与儿童不同的特殊生理特征。作者报告了一种针对成人先天性小耳畸形的有效耳支架制作技术。讨论了关于减少肋软骨获取量及增加软骨柔韧性的技术要点。
103例诊断为单侧先天性小耳畸形的成人患者接受了为期2年的皮肤扩张法治疗。采用拼接法制作耳支架。74例患者（35例耳垂型和39例耳甲型）取第七肋软骨制作耳支架。其余29例患者（19例耳垂型和10例耳甲型）则取第七和第八肋软骨制作耳支架。
84例患者（81.55%）对再造耳的效果满意。14例患者（13.60%）认为结果可接受，而5例患者（4.85%）认为结果不可接受。6例患者（5.82%）出现不同程度的吸收和软骨变形。5例患者（4.85%）发现钢丝外露。未出现与胸壁畸形相关或影响正常身体功能的术后并发症。93例患者（90.29%）胸壁恢复良好。10例患者（9.71%）胸部瘢痕增多。
与传统方法相比，所提出的技术是一种简单的方法，可有效治疗成人先天性小耳畸形患者。这种软骨获取和耳支架制作技术是成人先天性小耳畸形的合适治疗选择。
