He Leren, Zhang Jinguang, Jiang Haiyue, Yang Qinghua, Zhuang Hongxing
The Seventh Plastic Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Dec;26(12):1477-81.
To investigate the methods and effectiveness of ear reconstruction for the microtia patients with craniofacial deformities.
Between July 2000 and July 2010, ear reconstruction was performed with tissue expander and autogenous costal cartilages in 1 300 microtia patients with degree II+ hemifacial microsoma, and the clinical data were reviewed and analyzed. There were 722 males and 578 females, aged 5 years and 8 months to 33 years and 5 months (median, 12 years and 2 months). The expander was implanted into the retroauricular region in stage I; ear reconstruction was performed after 3-4 weeks of expansion in stage II; and reconstructed ear reshaping was carried out at 6 months to 1 year after stage II in 1 198 patients.
Of 1 300 patients, delayed healing occurred in 28 cases after stage II, healing by first intention was obtained in the other 1 272 cases, whose new ears had good position and appearance at 1 month after stage II. After operation, 200 cases were followed up 1-9 years (mean, 3 years). One case had helix loss because of trauma, and 1 case had the new ear loss because of fistula infection. At last follow-up, the effectiveness were excellent in 110 cases, good in 65 cases, and fair in 23 cases with an excellent and good rate of 88.4%.
It is difficulty in ear reconstruction that the reconstructed ear is symmetrical to the contralateral one in the microtia patients with degree II+ hemifacial microsoma. The key includes the location of new ear, the fabrication of framework, and the utilization of remnant ear.
探讨伴有颅面畸形的小耳畸形患者耳再造的方法及效果。
2000年7月至2010年7月，对1300例Ⅱ级以上半侧颜面短小畸形的小耳畸形患者采用皮肤扩张器联合自体肋软骨进行耳再造，并对临床资料进行回顾性分析。其中男722例，女578例，年龄5岁8个月至33岁5个月（中位数12岁2个月）。Ⅰ期在耳后区植入扩张器；Ⅱ期扩张3～4周后行耳再造；1198例于Ⅱ期术后6个月至1年进行再造耳修整。
1300例患者中，Ⅱ期术后28例出现延迟愈合，其余1272例均一期愈合，Ⅱ期术后1个月时再造耳位置、外形良好。术后200例获1～9年（平均3年）随访。1例因外伤致耳轮缺失，1例因瘘管感染致再造耳缺失。末次随访时，效果优110例，良65例，可23例，优良率88.4%。
伴有Ⅱ级以上半侧颜面短小畸形的小耳畸形患者耳再造时，使再造耳与对侧耳对称存在困难。关键在于新耳位置的确定、支架的制作及残余耳的利用。
