Pribaz J J, Crespo L D, Orgill D P, Pousti T J, Bartlett R A
Division of Plastic Surgery, Brigham and Children's Hospitals, Boston, Mass., USA.
Plast Reconstr Surg. 1997 Jun;99(7):1868-72. doi: 10.1097/00006534-199706000-00009.
Reconstitution of the amputated ear remains a challenge to the plastic surgeon. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases; however, difficulty with adequate venous drainage complicates the technical complexity of these cases. To enhance survival of a reattached ear segment, Mladick et al. advocated use of the retroauricular pocket principle. This technique involves deepithelialization of the amputated part, followed by anatomic reattachment to the amputation stump and then burial in a retroauricular pocket. This simple technique increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of "take." The relationship between the dermis and cartilage is preserved, thus minimizing the deformity from cartilage warping. The undisturbed dermis on the involved segment can reepithelialize spontaneously, negating the need for a skin graft. We have used this technique successfully in five of six patients.
对整形外科医生来说，再造被截断的耳朵仍然是一项挑战。将完全或部分截断的耳朵作为复合移植物重新附着并不可靠。少数情况下可进行显微外科再植；然而，充分的静脉引流困难使这些病例的技术复杂性增加。为提高重新附着的耳部节段的存活率，姆拉迪克等人主张采用耳后袋原理。该技术包括将截断部分的上皮去除，然后与截断残端进行解剖学重新附着，接着埋入耳后袋。这种简单技术增加了撕脱节段与周围营养物质接触的表面积，使“存活”的可能性最大化。真皮与软骨之间的关系得以保留，从而将软骨变形导致的畸形降至最低。受累节段未受干扰的真皮可自发重新上皮化，无需植皮。我们已在6例患者中的5例成功使用了该技术。
