Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Badachu Road No.33, Beijing, China.
Affiliate Hospital of Weifang Medical University, Yuhe Road No.2428, Weifang, China.
Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110470. doi: 10.1016/j.ijporl.2020.110470. Epub 2020 Oct 23.
Auricular reconstruction with tissue expansion has been widely used in children with microtia. Base on the experience of using tissue expander, more patients have undergone a modified auricular reconstruction using a framework wrapped by expanded skin flap without fascial and skin graft transplantation. Skin damage is a common complication that may lead to serious outcomes, such as infection and distortion. Promptly repair is particularly important when using this modified technique. This work aims to record the site and other information on damage to the expanded skin flap, and to apply various salvage methods according to the site and stage.
From January 2017 to September 2019, 170 patients who underwent total auricular reconstruction without fascial and skin graft were followed up. All patients who had skin damage received corresponding prompt treatment. Details on the site, occurrence time, and salvage methods were noted.
A total of 19 patients were found to have skin damage during the follow-up period. The defect size ranged from 10 mm to 70 mm. Four patients had skin damage in the lower part of the skin flap combined with expander exposure. The second stage of auricular reconstruction was carried out immediately. Two patients had skin flap damage in anterior 1/3rd of the helix, seven in middle 1/3rd of the helix, four in posterior 1/3rd of the helix and two in the triangular fossa. Most of the skin damage occurred within 4-9 months after auricular reconstruction. According to the site and other factors, the expanded skin flap with the exposed cartilage was repaired using local skin flap, retroauricular skin flap, and retroauricular fascia. Patients were satisfied with the outcome of the repair. Additional skin damage and other complications were not observed after the repair operations.
Skin damage is a common complication, and it should receive more attention while applying this modified auricular reconstruction using tissue expansion. The site, occurrence time, and other information provide reference to improve the reconstruction without fascial or skin graft transplantation. Salvage methods, such as retroauricular skin flap and retroauricular fascia, have been treated as highly efficient backup methods and have achieved satisfying results.
组织扩张在儿童小耳畸形中的应用已得到广泛认可。基于组织扩张器使用经验，我们对更多患者采用了经改良的耳再造术，使用扩张皮瓣包裹的框架，而无需筋膜和皮片移植。皮肤损伤是一种常见的并发症，可能导致严重后果，如感染和畸形。使用这种改良技术时，及时修复尤为重要。本研究旨在记录扩张皮瓣受损的部位和其他信息，并根据部位和阶段应用各种抢救方法。
2017 年 1 月至 2019 年 9 月，对 170 例无筋膜和皮片移植的全耳再造患者进行了随访。所有发生皮肤损伤的患者均接受了相应的及时治疗。记录了损伤部位、发生时间和抢救方法的详细信息。
在随访期间，共发现 19 例患者发生皮肤损伤。缺损大小为 1070mm。4 例患者皮瓣下部合并扩张器外露，二期行耳再造术。2 例螺旋前 1/3 处皮瓣损伤，7 例螺旋中 1/3 处皮瓣损伤，4 例螺旋后 1/3 处皮瓣损伤，2 例三角窝处皮瓣损伤。大部分皮肤损伤发生于耳再造后 49 个月。根据部位和其他因素，采用局部皮瓣、耳后皮瓣和耳后筋膜修复外露软骨的扩张皮瓣。患者对修复效果满意，修复后无其他皮肤损伤和并发症。
皮肤损伤是一种常见的并发症，在应用这种改良的组织扩张耳再造术时应更加重视。部位、发生时间和其他信息为改进无筋膜或皮片移植的重建提供了参考。耳后皮瓣和耳后筋膜等抢救方法已被视为高效的备用方法，取得了满意的效果。
