摘要目的 探讨完全扩张法耳再造术中残耳组织的利用方法.方法 2017年1月至2018年12月期间空军军医大学西京医院整形外科完成单侧先天性小耳畸形患者完全扩张法耳再造术156例,男106例,女50例,年龄7～50岁,平均13.6岁.手术分三期完成,一期扩张器置入术,二期耳再造术,半年后行三期再造耳廓修整术,根据小耳畸形类型及残耳形态设计手术方案,充分利用残耳进行耳垂及耳廓下部的重建(包括耳轮、对耳轮、耳甲腔的下半部分),残耳组织的利用方法为:不对称的Z形瓣设计,旋转耳垂并与再造耳进行衔接,形成流畅的耳轮缘;靠近耳甲腔处多余的残耳皮肤用来重塑对耳轮下半部分及加深部分耳甲腔.结果 所有患者术后均无感染、皮瓣血运不良等并发症发生.术后随访时间7～24个月,平均10个月,所有Ⅰ度小耳畸形患者耳垂及耳廓下部成形满意,残耳与再造耳廓衔接自然.Ⅱ度、Ⅲ度小耳畸形及残耳组织显著低位患者中,16例效果欠佳,主要问题为残耳过小导致的再造耳垂过小,以及残耳严重异位导致的转位后衔接处出现明显切迹及过渡不自然,其余患者效果满意.结论 针对小耳畸形的不同类型与残耳形态的分类设计手术方案,对多数接受耳再造术的患者可获得较理想的手术效果.

abstractsObjective This study aimed to present our clinical experience of the utilization of remnant ear for the inferior part and lobule reconstruction in microtia patient with the fully pre-expansion ear reconstruction technique. Methods During 2017. 01—2018. 12, 156 cases of unilateral ear reconstruction were performed. The operation was divided into three stages. Six months after the ear reconstruction, the third stage of the remnant ear utilization was performed. The surgery was planned according to the microtia classification and the remnant morphology. Results All the patients had no complications. Follow-up period ranged from 7—24 months, and ten months on average. All the patients with typeⅠmicrotia had satisfying results of the inferior part and lobule reconstruction. Sixteen cases of types Ⅱand Ⅲ microtia patients had unfortunate outcomes, because the residual ears were too small to reconstruct the earlobe, and the incisure appeared when remnant and reconstructed ear was connected in cases of severe remnant malposition. The rest of patients were satisfied with the reconstruction. Conclusions The utilization of the remnant ear based on the types of microtia and the remnant morphology could achieve the satisfying result of reconstruction for most of the microtia patients.