应用耳后皮瓣修复耳垂缺损

目的：探讨耳后乳突区皮瓣折叠并风筝皮瓣法进行耳垂重建的新方法及效果。方法：于耳后采用双叶形皮瓣折叠术进行耳垂重建同期采用乳突区下方＂风筝＂皮下蒂皮瓣作V-Y推进修复耳后缺损。结果：总结自2006年以来,应用耳后皮瓣折叠并风筝皮瓣法修复耳垂缺损患者5例,均一期完成,重建的耳垂形态自然流畅,供区瘢痕隐蔽。耳后缺损均无需另外植皮。结论：采用乳突区折叠皮瓣并风筝皮瓣进行耳垂重建方法,操作简单,创伤小,避免了耳后植皮造成皮片色素沉着。是一种安全、理想的耳垂再造方法。     

乳突区双叶皮瓣及Limberg皮瓣耳垂再造术

目的 探讨采用乳突区双叶皮瓣及Limberg皮瓣对不同程度的耳垂缺损畸形进行手术修复.方法 对收治的耳垂缺损畸形患者16例,根据耳垂缺损的大小分别采用不同的手术方式进行再造.9例缺损面积较小的耳垂缺损者,采用乳突区双叶皮瓣法再造;7例耳垂完全缺损或健侧耳垂较大者,采用Limbeerg皮瓣法进行再造.结果 16例皮瓣均成活,切口愈合良好,外形满意.术后随访3个月至4年,部分乳突区植皮成活后轻度色素沉积,但无大妨,耳垂外观良好,效果满意.结论 根据耳垂缺损畸形的具体情况采用乳突区双叶皮瓣及Limberg皮瓣进行再造,血供可靠,手术简便,损伤小,外形满意,是耳垂再造的较好方法.     

耳后扩张的瘢痕瓣加Medpor支架行耳廓再造术

目的：探讨采用耳后乳突区瘢痕扩张皮瓣和Medpor支架行瘢痕性耳廓缺损再造术的效果。方法：12例因烧伤致耳廓缺损,采用耳后瘢痕扩张皮瓣包裹Medpor支架作耳廓再造术。结果：术后经6个月～3年随访,再造的耳廓瘢痕皮瓣血运皆良好,再造耳外形满意。结论：耳后皮肤瘢痕经扩张后,仍可用于耳廓缺损的再造术。     

皮肤扩张联合自体软骨移植修复耳垂全缺损

目的：探讨皮肤扩张法在耳垂全缺损修复方面的应用。方法：对6例耳垂完全缺损的患者使用耳后扩张皮瓣联合自体肋软骨支架移植进行修复。结果：本纽患者均采用上述方法治疗,皮瓣全部成活,经过2～18个月的随访,再造耳垂形态良好,没有出现扭曲,变形的现象。耳后乳突区瘢痕不明显。结论：对耳垂完全缺损甚至包括部分耳廓缺损的患者,皮肤扩张法修复是一个应当首先选择的方法。     

瘢痕性隐耳的手术修复

目的探讨瘢痕性隐耳的定义及其伴有部分或完全耳垂缺损的手术修复效果。方法采用局部皮瓣加全厚皮片分区移植法，分别完成耳廓与颅侧壁及乳突部粘连松解、颅耳角形成、耳轮重建、耳垂再造或重建手术，对26例33只瘢痕性隐耳进行矫正。结果所有皮瓣均100％成活，移植皮片95％以上存活；耳廓外形尚较满意，主要结构可辨，颅耳角基本恢复。术后随访3个月至1年．结果表明，耳廓外形保持良好，患者满意。结论针对瘢痕性隐耳的畸形特征，采取相应的手术方法，是矫正瘢痕性隐耳的有效手段。     

耳下区皮瓣结合放射疗法治疗耳垂部瘢痕疙瘩

目的:探讨采用耳下区皮瓣转移结合术后放疗在耳垂部瘢痕疙瘩修复中的临床应用。方法:选择2015年以来笔者科室收治的6例耳垂部瘢痕疙瘩患者为研究对象,根据瘢痕疙瘩切除后耳垂缺损大小,设计并切取耳下区皮瓣折叠转移至瘢痕疙瘩切除区进行修复,术后行常规耳垂部放射治疗。结果:6例患者瘢痕疙瘩均无复发,再造耳垂全部成活,形态良好。结论:采用耳下区皮瓣转移结合放疗法治疗耳垂部瘢痕疙瘩,血运可靠,创伤小,是一种合理有效的治疗方法。     

耳下双蒂皮瓣行全耳垂缺损再造修复

耳垂缺损主要分为先天性和后天性两大类.前者在胚胎第48周时,由于发育障碍而致耳垂畸形,表现为耳垂缺损、耳垂过大、耳垂过长、耳垂尖角、耳垂裂等.在临床病例中以后天性耳垂缺损为多见,如外伤、烧伤、冻伤、肿瘤术后所致耳垂缺损等.近几年由于穿耳孔配戴耳饰的人增多,也由此导致耳垂瘢痕疙瘩增多,更为耳垂缺损增加一批新的患者.耳垂缺损的修复方法很多,常用的有耳后乳突区皮瓣法、Converse法和Brent法等[1].这些方法均是在乳突区、颈上部形成的单蒂皮瓣,供皮区需植皮,有时尚需2次手术.笔者设计了一种耳下双蒂皮瓣行全耳垂缺损再造修复方法,现报道如下.     

残耳逆行转位在低位残耳患者耳再造中的应用

目的探讨先天性小耳畸形合并低位残耳患者耳垂的处理方法。方法自2010年10月至2014年6月,对42例小耳畸形合并半侧颜面短小症耳垂低位的患者,采用扩张法或者改良Nagata方法进行外耳再造术。由于残耳组织较健侧耳位置低,其处理采用逆行耳垂转位的方法,即以残耳上部为蒂,将残耳中下部掀起形成耳垂皮瓣,将耳垂皮瓣向上向后旋转,与耳后乳突区皮瓣相衔接,覆盖软骨支架的下端,形成耳垂和耳轮的一部分。切取残耳的创面采用直接缝合方法。结果 42例患者残耳逆行移位后,耳垂血运良好,再造耳耳垂存活良好,无破溃;所有患者获随访2个月至2年,再造耳与健侧耳位置基本对称,利用残耳逆行转位形成的耳垂形态自然。结论残耳逆行移位行耳垂再造,对于半侧颜面短小残耳位置明显低于健侧者,是一种安全有效的处理方法。     

异位的耳垂型残耳在小耳畸形外耳再造中的应用

目的：探讨小耳畸形外耳再造术中异位的耳垂型残耳的应用方法。方法：根据耳垂型残耳的不同位置，分别采用“V-Y”推进、Z成形术、残耳向上逆转、单蒂顺时针旋转等方法矫正残耳耳垂位置。结果：残耳耳垂经改形或转位后血运良好，全部成活，以残耳形成的耳垂外形自然，并获得理想的再造耳位置。结论：异位的残耳耳垂位置的调整是成功施行外耳再造术、保证再造耳与健侧耳对称的重要环结，以残耳形成的耳垂能使再造耳廓外形更自然，更逼真，应尽可能充分应用。     

耳下双蒂皮瓣行全耳垂缺损再造修复

耳垂缺损主要分为先天性和后天性两大类。前者在胚胎第 48周时 ,由于发育障碍而致耳垂畸形 ,表现为耳垂缺损、耳垂过大、耳垂过长、耳垂尖角、耳垂裂等。在临床病例中以后天性耳垂缺损为多见 ,如外伤、烧伤、冻伤、肿瘤术后所致耳垂缺损等。近几年由于穿耳孔配戴耳饰的人增多 ,也由此导致耳垂瘢痕疙瘩增多 ,更为耳垂缺损增加一批新的患者。耳垂缺损的修复方法很多 ,常用的有耳后乳突区皮瓣法、Ｃｏｎｖｅｒｓｅ法和Ｂｒｅｎｔ法等[1 ] 。这些方法均是在乳突区、颈上部形成的单蒂皮瓣 ,供皮区需植皮 ,有时尚需 2次手术。笔者设计了一种耳下双…     

Firm elevation of the auricle in reconstruction of microtia with a retroauricular fascial flap wrapping an autogenous cartilage wedge.

During conventional reconstruction of the auricle in patients with microtia, simply separating the auricle from the mastoid region with a full-thickness skin graft usually fails to create firm elevation and sufficient projection. To achieve frontal symmetry is difficult, and sometimes the normal auricle needs to be set back. We reconstructed the auricle in patients with microtia in two major stages using a modified Nagata's method. Using a wide W-incision skin flap, the first stage includes implantation of a cartilage framework and transposition of the ear lobule. Our modification lies in the second stage. Instead of using the superficial temporoparietal fascial flap, we elevated a retroauricular fascial flap from the mastoid region, turning it over to wrap an autogenous costal-cartilage wedge, and covered it with a full-thickness skin graft. Between June 1996 and May 1999, eight patients underwent this operation. All the fascial flaps and overlying full-thickness skin grafts survived well. The advantages of our technique include firm elevation, good frontal projection and a natural appearance of the posterior aspect of the ear. Additionally, by using this fast and practical procedure, we avoid creating additional scars on the scalp and preserve the superficial temporoparietal fascia and superficial temporal vessels.     

耳后推进皮瓣联合肋软骨移植一次性修复部分耳廓缺损

目的：介绍一种一次性修复外伤后部分耳廓缺损的方法。方法：以耳廓缺损缘为蒂形成耳后推进皮瓣,取自体肋软骨雕刻成片状支架与缺损缘拼接,形成耳后筋膜瓣覆盖支架后侧,联合肋软骨供区全厚皮片移植一次性修复部分耳廓缺损。结果：临床应用8例,缺损一次性修复,双侧耳对称,外形满意。结论：联合应用以缺损缘为蒂的耳后推进皮瓣及自体肋软骨移植技术可一次性修复外伤性部分耳廓缺损,具有治疗周期短、效果可靠的特点。     

Modification of the second stage of auricular elevation in Nagata's technique for treating microtia

The ultimate goal in treating congenital microtia is the reconstruction of an auricle with a natural appearance as close as possible to the healthy one in terms of shape, contour, size, texture, position, and projection. Here we present another option to the second stage of raising the ear in Nagata's technique for treating microtia. The first step includes implantation of a cartilaginous framework and transposition of the ear lobe. Raising the cartilage leaves a skin defect behind the auricle. Instead of using a superficial temporoparietal fascia flap as described by Nagata, we raise a simple rotation flap from the mastoid and neck to close the defect with a minimal scar. The advantages of this technique include firm elevation, good frontal projection, and a natural appearance of the auriculo-cephalic sulcus with a normal retroauricular hairline. In addition, the procedure fast and practical, creates no additional scars on the scalp, and preserves the superficial temporoparietal fascia.     

Modification of the second stage of auricular elevation in Nagata's technique for treating microtia.

The ultimate goal in treating congenital microtia is the reconstruction of an auricle with a natural appearance as close as possible to the healthy one in terms of shape, contour, size, texture, position, and projection. Here we present another option to the second stage of raising the ear in Nagata's technique for treating microtia. The first step includes implantation of a cartilaginous framework and transposition of the ear lobe. Raising the cartilage leaves a skin defect behind the auricle. Instead of using a superficial temporoparietal fascia flap as described by Nagata, we raise a simple rotation flap from the mastoid and neck to close the defect with a minimal scar. The advantages of this technique include firm elevation, good frontal projection, and a natural appearance of the auriculo-cephalic sulcus with a normal retroauricular hairline. In addition, the procedure fast and practical, creates no additional scars on the scalp, and preserves the superficial temporoparietal fascia.     

颞浅血管岛状皮瓣修复全耳垂缺损

目的 探讨一种修复全耳垂缺损的方法.方法 在耳轮脚前上方切取由颞浅虹管供血的岛状皮瓣,通过皮下隧道转移自相折合修复全耳垂缺损畸形.结果 自1999年以来,于临床应用6例,术后皮瓣全部成活,无并发症发生,耳垂外形良好,色泽自然.随访3个月至1年,无需二期修复,所有患者对再造耳垂形态满意.供区瘢痕不明显.结论 利用耳轮脚前上方颞浅血管岛状皮瓣修复全耳垂缺损,是一期全耳垂再造的较好方法.     

皮下蒂皮瓣与旋转皮瓣在颞部皮肤缺损修复中的联合应用

目的：探讨利用耳前邻近皮瓣与颞区邻近皮瓣联合应用修复颞部皮肤缺损的方法。方法：根据患者颞部皮肤肿物的大小,设计患侧耳前方皮下蒂皮瓣的切取范围并将切口线设计在耳前皱襞上。在颞部肿物外缘向耳上方延长切口线约为皮肤肿物直径的4倍,设计旋转皮瓣。2个皮瓣联合应用,修复颞部较大面积皮肤缺损。供区直接缝合。结果：共施行此类手术12例,患侧皮肤缺损修复满意,切口线相对隐蔽,面部器官形态功能均未受到影响,供区头发自然生长,瘢痕不明显。结论：利用皮下蒂皮瓣与旋转皮瓣联合修复颞部较大面积皮肤缺损,辅助切口少且切口隐蔽,同时皮瓣转移后自然平滑过渡,创面修复满意,无需植皮,瘢痕不明显。     

超薄扩张皮瓣自体肋软骨支架耳廓再造术

目的:探讨超薄扩张皮瓣自体肋软骨支架耳廓再造术的临床效果。方法:采用乳突区皮肤扩张,自体肋软骨支架耳廓再造。结果:1例皮肤扩张器外露,其余11例患者手术成功。再造耳廓大小、外形与健侧相似,医患双方满意。结论:耳后乳突区皮肤扩张后皮瓣薄,自体肋软骨作为耳支架耳廓再造,术后耳廓外形逼真、立体感强,是目前最可靠和最可取的方法。     

One stage reconstruction of auricle with partial defect after trauma]

An improved method for one stage reconstruction of partial defect of the ear lobe is reported. A postauricular mastoid skin flap is constructed with the pedicle on the margin of the defect of the ear. If necessary, the distal part of the flap may carry a piece of subcutaneous tissue of the scalp to cover the framework. The operation has been done in 19 patients with satisfactory results.     

A new skin flap method for total auricular reconstruction: extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap: four skin flaps and temporoparietal fascia flap

A sufficient skin envelope of good quality as well as definite auricular framework is a prerequisite for a successful auricular reconstruction. Various surgical techniques, such as recruitment of mastoid skin, skin graft, tissue expansion, and so on, have been used to get the necessary skin for covering of the auricular framework. However, debates about the drawbacks of these techniques have continued. In this article, I report on a new skin flap method for total auricular reconstruction, which is an extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap. Between January 2009 and March 2010, a total of 20 patients underwent an auricular reconstruction using a Medpor framework (Porex Surgical, Inc, Newnan, GA) and the new skin flap method. Follow-up time range was 4 to 17 months. The reconstructed ear showed no definite true hair growth except for some fine hair, which can be ignored. More favorable results such as a good color matched skin, well-formed ear convolution, no other donor site scars can now be achieved using this new method.