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。     

应用矩形皮瓣法修复先天性隐耳畸形

目的 探讨应用矩形皮瓣法修复先天性隐耳畸形的可行性.方法 2001至2004年,对9例共15侧行矩形皮瓣法隐耳整复术,其中双侧6例,单侧3例.将患耳的上半部从头皮中牵出,参照:Hyakusoku矩形皮瓣法,在耳廓上后方设计由2个三角形皮瓣和1个矩形皮瓣组成的"三瓣"(故也可称为三瓣法).按设计切口切开皮肤,游离皮瓣,对耳横肌、耳斜肌的短缩切开分离松解,并切开松解耳上肌纤维组织,最后转移皮瓣,缝合皮肤.结果 所有皮瓣均未出现血运障碍,手术切口愈合良好.随访3个月至2年,患耳功能和外形均较满意.结论 矩形皮瓣法适用于轻、中度隐耳畸形,可给患耳上后部提供足够的皮肤组织,颅耳沟成形好,供区损伤轻.     

Our preferred surgical approach to cicatricial cryptotia

Background

Adhesions between the auricle and retroauricular cranial wall and mastoid occur after burns to this area due to cicatricial contracture, leading to the distortion of the otocranial angle and obscuring the remnant auricle in the scar. A definition of cicatricial cryptotia was devised to describe the ear deformity after burn by the authors, and a novel surgical approach to cicatricial cryptotia was employed to reconstruct the auricle.

Patients and methods

A total of 33 ears in 26 adult patients were operated upon. As many as 19 cases of cicatricial cryptotia were unilateral, seven cases bilateral. The patients’ age ranged from 19 to 31 years. Because of a lack of normal tissues surrounding the remnant ear, a periauricular cicatricial flap was designed to repair the helix and antihelix defect and a horizontal bifoliate skin flap for earlobe reconstruction. Two triangular cicatricial flaps located at the cephalic or caudal direction of the survival ear were used for shaping the otocranial angle and auriculotemporal sulci, combined with zoned transplantation of a full-thickness skin graft.

Results

All cicatricial flaps demonstrated nearly 100% survival and the take rate of transplanted skin grafts was approximately 95%. The main structures were visible and cosmetically acceptable; the otocranial angle and auriculotemporal sulci were acceptably restored. The function of wearing eye glasses or a mask was regained. The patients were followed up from 3 months to 6 years after surgery; the mean follow-up period was 3.2 years. The contour of the reconstructed auricle was maintained well, and the scar contracture was acceptable.

Conclusion

Periauricular cicatricial flaps combined with skin grafting is a new approach to cicatricial cryptotia when auricle reconstruction after burn is limited by a scarcity of supple, elastic local skin and fascia.     

旋转皮瓣加植皮法矫治隐耳畸形

目的:介绍一种矫正隐耳畸形简单、可靠的方法。方法:分析我科自2000年~2004年应用耳廓上部三角形皮瓣向下旋转加植皮法,矫治的隐耳畸形患者56例(74耳),其中双侧18例,术后随访3个月～4年。结果:所有被矫治的隐耳均获得了满意而稳定的外形。结论:本手术方法简单、切口隐蔽、损伤小、效果佳,是矫正隐耳畸形较理想的手术方法。     

Alternative surgical methods of treatment for the constricted ear

There have been numerous articles published on surgical correction of the constricted ear where the auricular defect was described in detail or classified in addition to their suggested surgical treatment methods or techniques. As for the surgical method introduced by Stephenson and modified by Musgrave it is worthy to note that the technique for the expansion and reinforcement of the auricular cartilage is useful, especially for corrective surgery for cryptotia cases. All articles concerned with surgery involving with the auricle are of importance to young surgeons who seek to pursue a clinical practice involving corrective and reconstructive surgery of the auricle. One must consider not only the selection of the surgical method or technique but also the importance in planning the surgery to correct the defect and in the selection of the material required to correct the defect or to reconstruct the auricle. The ultimate goal is to attain consistent, satisfactory, and favorable results, the appearance of a normal auricle.     

隐耳畸形矫正手术方法及疗效探讨

目的:探讨矫正隐耳畸形的手术方法和疗效。方法:选取2009~2012年收治的患者11例(15耳),其中双侧4例,对隐耳畸形患者行松解定位加植皮法治疗。结果:本组患者11例(15耳)术后随访3个月~1年,被矫治的隐耳均获得满意且稳定的外形。结论:本手术方法简单,术后耳廓形态自然,左右耳高度和角度对称,瘢痕更加隐蔽,是矫正隐耳畸形较理想手术方法。     

Z成形术加游离植皮法矫治隐耳畸形

目的：探讨Z成形术加游离植皮法矫正隐耳畸形的疗效。方法：对我科2008年至2010年16例（24耳）隐耳畸形患者应用耳廓Z成形术加植皮法进行治疗。结果：本组患者16例（24耳）,其中双侧8例,术后随访3个月～1年,被矫治的隐耳均获得了满意而稳定的外形。结论：本手术方法简单、术后耳廓形态自然,是矫正隐耳畸形较理想手术方法。     

Surgical correction of cryptotia using Medpor.

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.     

Surgical correction of congenital cryptotia

From 1983 to 1988, we have operated on eight cases of cryptotia. The method of operation was to deepen the cephalo-auricular sulcus and to obtain a normal position of the ear. 1. The local flap usually used is either a V-Y advancement flap or a rotated flap. The author designs two V flaps, the upper one near the auricle is rotated to provide tissue between the upper part of the auricle and temporal region which should be dissected deep enough. The other V-Y advancement flap is used to increase the transverse length of the auricle. 2. The contracted transverse, oblique and superior auricular muscular fibres are dissected. In children the insertion of the superior auricular muscle is transposed and sutured to the eminentia fossae. 3. The repair of the cartilagenous deformity of the auricle includes placing two to three parallel incisions on the back of the superior part and elevating and suturing the angulated superior third helix to the cut edge of the back of the auricle. Good results were obtained in all cases.     

An alternative technique for correction of cryptotia

Cryptotia is rare in the western world, and consequently any one surgeon's experience with its correction is limited. A procedure for the correction of cryptotia is described, which takes into account the details of the deformity. It adds skin flap from the preauricular tissue to cover the reconstructed cartilage of the anterior and superior helix. Two patients with cryptotia were treated with this technique, and good postoperative results were achieved.     

The square flap method

We report a method for increasing the distance between two points on the skin surface by using two triangular flaps and a square flap. The theoretical lengthening is excellent when one of the triangular flaps is right-angled. The method has been used successfully in 40 cases of scar contracture, various clefts and cryptotia.     

A tie-over with "untied" parallel stitches: a useful technique for fixation of a bolster after treatment of cryptotia.

We describe a new technique for the treatment of cryptotia by which stitches for bolster fixation are inserted parallel to the auriculartemporal sulcus and temporarily left untied. After the bolster has been inserted into the temporal sulcus, the corresponding ends of the threads are tied to each other. Our technique is easy to use and secures a firm bolster fixation, and we recommend it for the treatment of cryptotia.     

A tie-over with “untied” parallel stitches: A useful technique for fixation of a bolster after treatment of cryptotia

We describe a new technique for the treatment of cryptotia by which stitches for bolster fixation are inserted parallel to the auriculartemporal sulcus and temporarily left untied. After the bolster has been inserted into the temporal sulcus, the corresponding ends of the threads are tied to each other. Our technique is easy to use and secures a firm bolster fixation, and we recommend it for the treatment of cryptotia.     

耳郭再造的再认识

耳郭再造技术的细节较多且难以把控,往往不易获得稳定效果。经过60余年的发展,该技术有了显著提高,Nagata二次法、部分扩张皮瓣法、完全扩张皮瓣法均得到了广泛应用。而获得再造耳满意效果和高优良率的前提是能够认识和理解每种再造方法,并根据患者的实际条件及每种耳郭再造技术的优势和不足,建立个性化治疗方案,有利于提高耳郭再造的整体效果和优良率。同时,也应对耳郭再造的整形医师进行系统规范培训,从而整体提高我国耳郭再造的技术水平。     

Correction of cryptotia using an external stretching device

An external stretching device was devised for the correction of cryptotia. A total of 27 cases of cryptotia received correction with this device. Patient age ranged from 10 to 40 years. During an earlier trial, patients were corrected with the external stretching device only. To make a definite and permanent projection of the upper ear, the external device had to be applied and maintained for more than 5 months. In some patients pin site infection developed during the treatment, which resulted in cessation of treatment. Recently, for cryptotia with marked cartilage adhesion, surgical release of the adhesion with a skin graft was supplemented with the application of the external stretching device. The device was maintained for 2 months and the long-term follow-up showed excellent outcome with well-maintained projection and a satisfactory auricular shape. The author suggests that the external stretching device is a useful alternative in the correction of cryptotia with severe cartilage adhesion in older children or adults.     

先天性小耳的耳廓再造

报道２２例先天性小耳症耳廓再造的方法及改进技术。采用软骨支架立体雕塑方法结合耳后支架埋置处皮肤急性扩张,及利用小耳组织重建耳垂、耳屏及耳甲腔,Ⅱ期手术耳廓掀起成形,行耳廓再造２２例。结果２２例患者,Ⅰ期耳廓支架埋入后均完全愈合,Ⅰ期术后可见埋置于皮下的立体感较强的再造耳形态,术中充分利用小耳组织,设计皮瓣及软骨皮瓣,Ⅰ期重建耳垂、耳屏及耳甲腔,取得良好效果,Ⅱ期耳廓掀起成形,外形满意。在耳廓再造术中,耳廓软骨支架的立体雕塑是本技术的关键,耳后皮肤的术中急性扩张,及充分利用小耳组织,改善再造耳廓形态,有助于塑造更完美的耳廓     

软骨支撑法隐耳畸形矫正术

目的　用自体肋软骨法支撑加固折叠皱缩的隐耳软骨矫正隐耳畸形。方法　用自体肋软骨片游离移植 ,从耳郭后部皮肤切口插入 ,使皱缩折叠的耳郭软骨支撑伸展。结果　本组采用软骨支撑法手术 4例 5侧耳郭 ,外形矫正满意。结论　用自体肋软骨移植支撑加固皱缩折叠的隐耳畸形软骨 ,颅耳沟成形好 ,软骨伸展的大小及形态易掌握 ,耳部损伤轻 ,是一种简便可靠、矫正后形态好的隐耳畸形手术方法。     

Aesthetic microtia reconstruction with Medpor

The complex architecture of the auricle makes it one of the most challenging structures for the reconstructive surgeon to re-create. Overlying the ear's unique cartilage framework are layers of varied soft tissues forming a three-dimensional organ, which is distinctively positioned on the head. Arguably, the most challenging auricle to reconstruct is third-degree microtia due to a near-total absence of native tissue and a need for lifelong durability of the reconstruction. Many methods of reconstruction have been studied; autogenous costal cartilage reconstruction has been one of the more traditional methods, with favorable long-term results reported by several surgeons. However, this technique requires tremendous artistic and technical skill on the part of the surgeon-sculptor to construct a realistic-appearing ear. High-density porous polyethylene (Medpor) is a stable, alloplastic implant that can integrate with host tissues, is resistant to infection, and has been successfully applied to reconstruction of the head and neck. For auricular reconstruction, Medpor--enveloped in a temporoparietal fascial flap with full-thickness skin graft coverage--is a durable and aesthetically gratifying alternative in microtic patients. This alternative surgical technique reduces surgical time and morbidity, standardizes results among surgeons, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.     

Secondary ear reconstruction using deep temporal fascia after temporoparietal fascial reconstruction in microtia

As anatomical study of the temporoparietal fascia (TPF) has advanced, there have been several reports on one-stage reconstruction of microtia using the TPF. To our knowledge, however, no report has described how to do secondary reconstruction if partial necrosis occurs, exposing the cartilage frame. Recently we treated a case of microtia that had become partially necrotic after the patient underwent one-stage reconstruction using the TPF. The deep temporal fascia was elevated to cover the necrotic portion and ensure successful placement of the skin graft. This technique greatly enhances one-stage reconstruction of the auricle using a TPF flap.     

Reconstruction of Auricular Defect with Perichondrial Graft: A New Technique: Case Report

A new technique is introduced to reconstruct defects of the auricle. The neochondrogenic capacity in a free graft of the auricular perichondrium is used to build the cartilaginous framework in the missing part of the auricle. By using local flaps and skin grafts for coverage of the newly formed cartilage the missing part of the auricle is satisfactorily reconstructed.