Ou Yangxue, Cao Tongyu, Zhang Qingguo, Liu Tun
Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Jan;9(1):61. doi: 10.21037/atm-20-8015.
Total auricular reconstruction is a challenge for plastic surgeons. Expanded flap method and Nagata's method with autologous costal cartilage are two leading techniques for ear reconstruction. And a two-stage strategy of expanded flap method received attention. In the present study, we report the incision and flap design of this strategy.
In the first stage, an 80 mL kidney-shaped expander was inserted in the mastoid region with the larger pole superiorly. The expander pocket was dissected subcutaneously in the scalp area and subfascially in the lower third region. In the second stage, the expander was removed from a Y-shaped lobule incision on the remanent ear. Then the remnant ear was separated into three flaps: the posterior skin flap, anterior skin flap, and lobule flap. When the framework was fabricated, the base frame and the underlying pad, which enhanced the projection, were fixed together as a whole to provide a more prominent appearance. The framework was totally wrapped into the expanded single flap without free skin grafting. Lobule transposition and tragus construction were performed simultaneously instead of a third-stage surgery. The recipient bed of rotated lobule was resected only to the epidermal layer and the subcutaneous layer was preserved to avoid central necrosis.
A total of 21 patients received this strategy to reconstruct ear. With 3 months to 1.5 years of follow-up, 19 patients (90.5%) were satisfied with the reconstructed ears. 3 patients (14.3%) required further modification of reconstructed ear. No serious complications occurred during the procedures.
With a Y-shaped incision, three-flap design of remanent ear and lobule rotation to an epidermal-removal area, tissue expander removal and modification of remanent ear can be performed effectively to avoid necrosis and an extra operation.
全耳再造术对整形外科医生来说是一项挑战。扩张皮瓣法和采用自体肋软骨的Nagata法是耳部再造的两种主要技术。并且扩张皮瓣法的两阶段策略受到了关注。在本研究中，我们报告了该策略的切口和皮瓣设计。
第一阶段，将一个80毫升的肾形扩张器插入乳突区，较大的一端朝上。在头皮区域皮下和下三分之一区域筋膜下分离出扩张器腔隙。第二阶段，从残留耳部的一个Y形小叶切口取出扩张器。然后将残留耳部分离为三个皮瓣：后皮瓣、前皮瓣和小叶皮瓣。制作支架时，将增强突出度的基础支架和下方的衬垫整体固定在一起，以提供更突出的外观。支架完全包裹在扩张的单一皮瓣内，无需游离植皮。同时进行小叶移位和耳屏构建，而无需进行第三阶段手术。旋转小叶的受区仅切除至表皮层，保留皮下层以避免中央坏死。
共有21例患者采用该策略进行耳再造。随访3个月至1.5年，19例患者（90.5%）对再造耳满意。3例患者（14.3%）需要对再造耳进行进一步修整。手术过程中未发生严重并发症。
通过Y形切口、残留耳的三皮瓣设计以及将小叶旋转至去除表皮的区域，可有效进行组织扩张器取出和残留耳修整，避免坏死和额外手术。
