多孔高密度聚乙烯应用于扩张法耳郭再造术的临床研究

【作者】 宋春琼；

【导师】 庄洪兴；

【作者基本信息】 中国协和医科大学 ， 整形外科， 2005， 博士

【摘要】 目的 对先天性小耳或后天耳郭缺失患者应用扩张法耳郭再造术时，对于那些因年龄、瘢痕或严重的胸壁疾病等原因而不适合、不能或不愿取用自体肋软骨的患者，探讨应用多孔高密度聚乙烯(Medpor)作为再造耳支架的可行性。 方法 对61例先天性小耳或后天耳郭缺失患者，应用耳后软组织扩张法，以Medpor为支架行耳郭再造术。手术分二期，一期：耳后皮肤软组织扩张器置入术。外伤性耳缺损耳后乳突区为瘢痕者，扩张器埋置于瘢痕瓣下。二期：耳郭再造术。以耳后扩张皮瓣或扩张的耳后瘢痕瓣和乳突区皮下组织筋膜瓣覆盖Medpor支架，再造耳郭。 结果 61例患者耳郭再造手术均正常痊愈出院。并分别进行了6个月到5.1年(平均2.8年)的随访，其中49例(占80.3％)患者对手术结果满意，再造耳与健侧(或双侧再造耳)大小、位置对称，轮廓清晰，形态逼真；7例(11.5％)认为再造耳手术效果一般；3例(4.9％)因发生了支架外露或再造耳形态不良等原因，表示对手术结果不满意；2例(3.3％)因担心发生支架外露，于术后半年行自体肋软骨移植置换Medpor支架，手术结果令其满意。 3例支架外露分别发生于术后7、9、12个月，由于外伤或无足够的皮下组织筋膜瓣覆盖支架等原因所致，经颞浅筋膜岛状瓣结合中厚植皮或局部皮瓣转移等修复，并随访6～26个月，效佳无复发。更多还原

【Abstract】 Objective To explore the feasibility of applying porous high-density polyethylene (Medpor) as framework to auricle reconstruction for congenital or acquired auricular defects victims unfit or reluctant to undergo autogenous costal cartilage taking.Method 61 cases suffering from congenital or acquired auricular defects underwent auricle reconstruction with Medpor framework after expanding postauricular skin. The operation was performed by two-stages. First stage: To implant expander underneath postauricular skin or soft tissue such as notrophic scar tissue for the traumatic auricle defect victims. Second stage: To remove expander and perform auricle reconstruction placing Medpor framework between the expanded skin/scar flap and the underlying fascial flap.Results 61 cases all obtained successful reconstructed auricles. During follow up of 6 months to 5.1 years ( average at 2.8 years), the reconstructed auricles in 49 cases (80.3%) resembled their unaffected or other reconstructed ones by size and position, with verisimilar shape, clear contour and distinct auricular anatomic structures, whereas 7 cases (11.5%) evaluated their reconstructed auricles ordinarily, 3 cases (4.9%) complained the operation results for uncovering of partial auricular frame or dissatisfactory auricle shape, and 2 cases (3.3%) afraid of emergence of更多还原