Nagata S
Department of Reconstructive Plastic Surgery, Tokyo Senbai Hospital, Japan.
Plast Reconstr Surg. 1994 Aug;94(2):254-65; discussion 266-7.
Unfavorable results in reconstruction of the auricle for microtia can be encountered from time to time, in which secondary reconstruction of the auricle is usually performed. One must note that secondary reconstruction is much more difficult than primary reconstruction for the following reasons: (1) all necrotic skin and scar tissue from the primary reconstruction must be removed, thus limiting the surface area of the skin for the secondary reconstruction; (2) the presence of scar tissue and loss of tensility in the subdermal layer makes it difficult to construct a subcutaneous pocket for grafting of the three-dimensional costal cartilage framework; and (3) in patients with full-thickness skin grafts in the conchal and postauricular regions, contraction of the grafted skin was noted. In order to resolve these problems, the temporoparietal fascia flap was used in the first-stage three-dimensional frame grafting operation, and the innominate fascia flap, obtained from the same site as the temporoparietal fascia in the first-stage operation, was used for the second-stage operation. The retroauricular full-thickness skin graft was utilized for color match on the anterior surface of the auricle where it is visible, and substitute skin from the groin was used to cover the donor site. The procedures and results for secondary reconstruction for unfavorable microtia are presented in this article.
小耳畸形耳廓再造有时会出现不理想的结果，这种情况下通常需要进行耳廓二期再造。必须注意的是，二期再造比一期再造困难得多，原因如下：（1）一期再造后的所有坏死皮肤和瘢痕组织都必须清除，这就限制了二期再造可用的皮肤表面积；（2）瘢痕组织的存在以及皮下层张力的丧失，使得难以构建用于移植三维肋软骨支架的皮下腔隙；（3）在耳甲腔和耳后区域采用全厚皮片移植的患者中，发现移植皮肤出现了收缩。为了解决这些问题，在一期三维框架移植手术中使用了颞顶筋膜瓣，在二期手术中使用了与一期手术中颞顶筋膜取自同一部位的无名筋膜瓣。耳后全厚皮片用于耳廓前表面可见部位的颜色匹配，腹股沟替代皮肤用于覆盖供区。本文介绍了小耳畸形二期再造的手术步骤和结果。
