上下耳轮角皮瓣在Nagata 二期耳廓再造术中的应用(1)
[摘要]目的：探讨上下耳轮角皮瓣在Nagata 二期耳廓再造颅耳角成形术中的应用及其临床效果。方法：2016年6月-2017年6月，对5例Nagata 一期术后3～6个月的先天性单侧小耳畸形患者进行了二期耳廓成形及颅耳角重建：将耳廓支架掀起，软骨支架置入颅耳沟，耳后筋膜包裹，在乳突区设计两长条形上下耳轮角皮瓣，于贴近颅耳沟处相互拉拢，交叉间断缝合，余创面植皮。结果：本组5例患者，随访6～12个月，5例患者上下耳轮角皮瓣均全部成活，耳廓与头颅侧壁约成30°夹角，形成清晰明显的颅耳沟，临床效果满意。结论：Nagata 二期耳廓再造术中应用肋软骨支架联合上下耳轮角皮瓣进行颅耳角重建可呈现满意的颅耳角结构，且操作相对简单，不增加手术次数，术后耳后皮片瘢痕挛缩率低，使其更具立体感，术后效果满意，值得临床推广应用。
[关键词]耳再造；局部皮瓣；颅耳角；整复外科手术；先天畸形
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0095-03
, 百拇医药
Application of Upper and Lower Helix Angle Skin Flap in Nagata Stage Ⅱ Ear Reconstruction
HE Meng-nan1，PEI Jie2，LU Yan1，GAO Xiao-bo1，WANG Xiao-bing1
(1.Department of Plastic Surgery，the First Clinical Hospital of Shanxi Medical University，Taiyuan 030001，Shanxi，China；
2.Department of Plastic Surgery，Shanxi University Hospital，Taiyuan 030000，Shanxi，China)
Abstract： Objective To investigate the application and clinical effect of upper and lower helix angle skin flap in Nagata Ⅱ auricle reconstruction. Methods We observed 5 patients who were diagnosed with congenital unilateral microtia and experienced Nagata stage Ⅰ operation. They underwent stage Ⅱ auricular forming and reconstruction of the cranioauricular angle from June 2016 to June 2017. Brief surgical procedure： lifted auricle scaffold， placed the cartilage scaffold in the cranial groove， and posterior auricular fascia encapsulated cartilage scaffolds.Two long strips of helix angle skin flap were designed in the mastoid region. Close to the cranial groove， draw each other， cross and suture. Skin graft on the remaining wounds. Results We followed up for 6-12 months. The clinical effect of all cases was remarkable. Skin flap survived. The angle between the auricle and the lateral side of the skull was about 30 degrees， and the cranial groove formed clearly and obviously. Conclusion The application of costal cartilage scaffold combined with upper and lower helix angle skin flap for reconstruction of cranioauricular angle in Nagata II ear reconstruction may present a more stereoscopic and satisfactory cranioauricular angle structure.The operation is relatively simple. It dose not increase the number of operation and it may low the rate of scar contracture after the operation. It is worthy of clinical application.
, 百拇医药
Key words： auricular reconstruction； local flap； cranioauricular angle； surgical repair； congenital malformation
在五官再造手術中，耳廓复杂、精致的三维立体结构使其成为最具挑战性的再造手术之一。上世纪50年代美国Tanzer[1]以自体肋软骨为再造耳廓支架材料分期行耳廓再造，开创了耳再造手术的新纪元，自此，众多学者对耳廓再造术进行了进一步探索及改进[2-5]，其中Nagata 二期耳廓再造术因其具有操作简捷、二期手术时间可自主选择、一期术后再造耳的轮廓即清晰可见等诸多优点而被广泛接受[6-8]。但Nagata 二期耳廓再造手术中耳后及乳突区创面采用整张游离皮片修复，术后常因皮片出现不同程度的瘢痕挛缩，造成颅耳沟变浅甚至消失，导致耳廓牵拉、变形、贴敷于耳后乳突区，使再造耳结构不清，外形欠佳，从而影响手术效果。, 百拇医药(贺梦男 裴洁 逯艳 高晓博 王小兵)
[关键词]耳再造；局部皮瓣；颅耳角；整复外科手术；先天畸形
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0095-03
, 百拇医药
Application of Upper and Lower Helix Angle Skin Flap in Nagata Stage Ⅱ Ear Reconstruction
HE Meng-nan1，PEI Jie2，LU Yan1，GAO Xiao-bo1，WANG Xiao-bing1
(1.Department of Plastic Surgery，the First Clinical Hospital of Shanxi Medical University，Taiyuan 030001，Shanxi，China；
2.Department of Plastic Surgery，Shanxi University Hospital，Taiyuan 030000，Shanxi，China)
Abstract： Objective To investigate the application and clinical effect of upper and lower helix angle skin flap in Nagata Ⅱ auricle reconstruction. Methods We observed 5 patients who were diagnosed with congenital unilateral microtia and experienced Nagata stage Ⅰ operation. They underwent stage Ⅱ auricular forming and reconstruction of the cranioauricular angle from June 2016 to June 2017. Brief surgical procedure： lifted auricle scaffold， placed the cartilage scaffold in the cranial groove， and posterior auricular fascia encapsulated cartilage scaffolds.Two long strips of helix angle skin flap were designed in the mastoid region. Close to the cranial groove， draw each other， cross and suture. Skin graft on the remaining wounds. Results We followed up for 6-12 months. The clinical effect of all cases was remarkable. Skin flap survived. The angle between the auricle and the lateral side of the skull was about 30 degrees， and the cranial groove formed clearly and obviously. Conclusion The application of costal cartilage scaffold combined with upper and lower helix angle skin flap for reconstruction of cranioauricular angle in Nagata II ear reconstruction may present a more stereoscopic and satisfactory cranioauricular angle structure.The operation is relatively simple. It dose not increase the number of operation and it may low the rate of scar contracture after the operation. It is worthy of clinical application.
, 百拇医药
Key words： auricular reconstruction； local flap； cranioauricular angle； surgical repair； congenital malformation
在五官再造手術中，耳廓复杂、精致的三维立体结构使其成为最具挑战性的再造手术之一。上世纪50年代美国Tanzer[1]以自体肋软骨为再造耳廓支架材料分期行耳廓再造，开创了耳再造手术的新纪元，自此，众多学者对耳廓再造术进行了进一步探索及改进[2-5]，其中Nagata 二期耳廓再造术因其具有操作简捷、二期手术时间可自主选择、一期术后再造耳的轮廓即清晰可见等诸多优点而被广泛接受[6-8]。但Nagata 二期耳廓再造手术中耳后及乳突区创面采用整张游离皮片修复，术后常因皮片出现不同程度的瘢痕挛缩，造成颅耳沟变浅甚至消失，导致耳廓牵拉、变形、贴敷于耳后乳突区，使再造耳结构不清，外形欠佳，从而影响手术效果。, 百拇医药(贺梦男 裴洁 逯艳 高晓博 王小兵)