Refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery
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摘要:
目的 总结全扩张法耳郭再造术的精细化操作方案及临床疗效。 方法 该研究为回顾性病例系列研究。2015年7月—2025年6月,空军军医大学第一附属医院整形外科收治1 136例（1 187只耳）符合入选标准的先天性小耳畸形患者,其中男781例、女355例,年龄8~40岁。对患者行全扩张法耳郭再造术,手术分3期进行,Ⅰ期行皮肤软组织扩张器置入术,Ⅱ期行肋软骨取出+扩张皮瓣和残耳处理+软骨支架制作及植入术,Ⅲ期行残耳修整+耳垂转位术。观察并记录Ⅰ、Ⅱ、Ⅲ期术后发生的并发症,计算总体并发症发生率。末次随访时,采用自制的满意度评分表调查患者对手术效果的满意度并计算满意率。 结果 33例患者术后出现血肿,其中17例患者在Ⅰ期术后出现、15例患者在Ⅱ期术后出现、1例患者在Ⅰ期和Ⅱ期术后均出现。15例患者在Ⅱ期术后出现软骨支架感染,3例患者在Ⅱ期术后出现耳轮软骨断裂,12例患者在Ⅱ期术后出现软骨支架变形。患者总体并发症发生率为5.5%（63/1 136）。Ⅲ期术后3个月~4年末次随访时,957例患者对手术效果表示满意,156例患者表示基本满意,23例患者表示不满意,满意率为98.0%（1 113/1 136）。 结论 采用全扩张法耳郭再造术治疗先天性小耳畸形,扩张后的皮肤组织量充足,无须植皮,再造耳郭形态佳,并发症少,患者对手术效果的满意度高。 Abstract:Objective To summarize the refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery. Methods This study was a retrospective study of case series. From July 2015 to June 2025, 1 136 patients (1 187 ears) with congenital microtia who met the inclusion criteria were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University, including 781 males and 355 females, aged 8-40 years. All the patients underwent total expansion auricular reconstruction surgery, which was performed in 3 stages, including skin and soft tissue expander implantation in the stage Ⅰ surgery, costal cartilage harvesting+expanded flap and residual ear management+cartilage framework fabrication and implantation in the stage Ⅱ surgery, and residual ear revision+earlobe transposition in the stage Ⅲ surgery. The postoperative complications in stages Ⅰ, Ⅱ, and Ⅲ were observed and recorded, and the complication rate was calculated. At the last follow-up, patients' satisfaction with the surgical outcome was surveyed using a self-designed satisfaction scale, and the satisfaction rate was calculated. Results Postoperative hematoma occurred in 33 patients, including 17 cases after the stage Ⅰ surgery, 15 cases after the stage Ⅱ surgery, and 1 case after both the stage Ⅰ and Ⅱ surgeries. Cartilage framework infection occurred in 15 patients after the stage Ⅰ surgery, helix cartilage fracture occurred in 3 patients after the stage Ⅱ surgery, and cartilage framework deformation occurred in 12 patients after the stage Ⅱ surgery. The complication rate of patients was 5.5% (63/1 136). At the last follow-up during 3 months to 4 years after the stage Ⅲ surgery, 957 patients were satisfied with the surgical outcome, 156 patients were basically satisfied, and 23 patients were dissatisfied, with satisfaction rate of 84.2% (1 113/1 136). Conclusions Total expansion auricular reconstruction achieves sufficient skin tissue volume after expansion without skin grafting, a well-formed reconstructed auricle with few complications, and high patient satisfaction with the surgical outcome. -
参考文献
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图 1 应用全扩张法耳郭再造术对小耳畸形患者进行耳郭重建。1A、1B.分别为Ⅰ期术中于内窥镜下剥离扩张腔隙和电凝止血；1C.Ⅱ期术中,在内窥镜辅助下切取肋软骨；1D.Ⅱ期术中,在扩张皮瓣后上方设计“V”形切口；1E、1F.分别为Ⅱ期术中,雕刻好的肋软骨支架组成部分和使用钢丝缝线缝合固定好的软骨支架；1G、1H.分别为Ⅲ期术中,于残耳耳垂和再造耳郭下极设计不对称“Z”形皮瓣的耳垂背面、正面切口；1I.Ⅲ期将残耳与再造耳郭衔接缝合及利用部分残耳进行耳屏重建后即刻效果
图 2 采用全扩张法耳郭再造术治疗例1患者左侧先天性小耳畸形的效果。2A、2B.分别为Ⅰ期术前患者面部正面观、左侧45°观,可见左侧先天性Ⅱ度小耳畸形,耳郭部分解剖结构缺失,呈垂直方向的“船形”残耳,残耳耳屏、对耳屏、耳垂结构完整；2C、2D.分别为Ⅰ期术后10周患者面部正面观、左侧45°观,可见扩张皮瓣长轴向前倾斜30°,上极高出对侧,皮瓣扩张充分、无明显破溃；2E、2F.分别为Ⅲ期术后2年患者面部正面观、左侧45°观,可见再造耳郭形态良好、亚单位结构清晰、仅存留线性瘢痕、与对侧正常耳郭基本对称
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