Kurabayashi Takashi, Asato Hirotaka, Suzuki Yasutoshi, Kaji Nobuyuki, Mitoma Yoko
Mibu and Koshigaya, Japan.
From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University Koshigaya Hospital.
Plast Reconstr Surg. 2017 Apr;139(4):935-945. doi: 10.1097/PRS.0000000000003228.
In two-stage procedures for reconstruction of microtia, an axial flap of temporoparietal fascia is widely used to cover the costal cartilage blocks placed behind the framework. Although a temporoparietal fascia flap is undoubtedly reliable, use of the flap is associated with some morbidity and comes at the expense of the option for salvage surgery.
The authors devised a simplified procedure for covering the cartilage blocks by creating a pocket in the postauricular temporoparietal fascia. In this procedure, the constructed auricle is elevated from the head superficially to the temporoparietal fascia, and a pocket is created under the temporoparietal fascia and the capsule of the auricle framework. Then, cartilage blocks are inserted into the pocket and fixed. A total of 38 reconstructed ears in 38 patients with microtia ranging in age from 9 to 19 years were elevated using the authors' method from 2002 to 2014 and followed for at least 5 months. To evaluate the long-term stability of the method, two-way analysis of variance (p < 0.05) was carried out to analyze the effect on the projection angles of the method (an axial temporoparietal fascia flap method versus a temporoparietal fascia pocket method) over long-term follow-up.
Good projection of the auricles and creation of well-defined temporoauricular sulci were achieved. Furthermore, the sulci had a tendency to hold their steep profile over a long period.
The temporoparietal fascia pocket method is simple but produces superior results. Moreover, pocket creation is less invasive and has the benefit of sparing temporoparietal fascia flap elevation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在先天性小耳畸形的两期重建手术中，颞顶筋膜轴型皮瓣被广泛用于覆盖置于支架后方的肋软骨块。尽管颞顶筋膜瓣无疑是可靠的，但使用该皮瓣会带来一些并发症，且是以牺牲挽救手术的选择为代价。
作者设计了一种简化手术方法，通过在耳后颞顶筋膜内制造一个腔隙来覆盖软骨块。在此手术中，将构建好的耳廓从头部表面提升至颞顶筋膜，然后在颞顶筋膜和耳廓支架包膜下方制造一个腔隙。接着，将软骨块插入腔隙并固定。2002年至2014年，作者采用该方法为38例年龄在9至19岁的先天性小耳畸形患者进行了38只耳廓再造，并进行了至少5个月的随访。为评估该方法的长期稳定性，采用双向方差分析（p<0.05）来分析该方法（轴型颞顶筋膜瓣法与颞顶筋膜腔隙法）在长期随访中对突出角度的影响。
实现了耳廓良好的突出效果，并形成了清晰的颞耳沟。此外，这些沟在较长时间内倾向于保持其陡峭的形态。
颞顶筋膜腔隙法简单但效果更佳。此外，制造腔隙的侵入性较小，且有利于避免颞顶筋膜瓣的掀起。
临床问题/证据级别：治疗性，IV级。
