【摘要】 耳郭再造主要涉及耳支架的构建和包覆耳支架的皮肤软组织选择。耳支架材料目前还没有完全理想化的生物材料,用于耳支架的材料包括自体肋软骨、医用硅橡胶和多孔聚乙烯等材料。自体软骨具有避免排斥反应、柔韧性好、容易与周围包裹组织相互结合生长、手术成本低等优点,但切取时会造成一定的损伤,增加了患者的痛苦,有胸廓结构改变和损伤以及软骨移植后易吸收和变形等缺点。硅胶支架具有外露率高、组织炎症反应高等缺点,限制了其在临床上的应用。Medpor外科种植体是近年应用于临床的新型医用化学合成材料,由线性高密度聚乙烯材料合成,具有可塑性强、手术时间缩短、与局部组织融合并稳妥固定、生物相容性较好等优点,但支架外露仍是最大的并发症。作者应用Medpor支架及扩张筋膜皮瓣的全耳郭再造手术治疗先天性小耳畸形、创伤所致外耳郭缺损、合并外耳道闭锁及听力障碍的外耳郭缺损12例,以耳后筋膜瓣和扩张皮瓣包裹形成再造耳郭,耳后筋膜瓣创面植皮。扩张后的耳后筋膜皮瓣改善了血运,包裹严密,减少了并发症,再造耳郭全部成活,无溃烂和支架外露发生,外观和质感接近正常耳郭。更多还原

【Abstract】 Auricle reconstruction involves auricular framework construction and selection of skin soft tissues that coats the auricular support. To date, there has no ideal biomaterial for the auricular framework. The materials of auricular framework include autologous costal cartilage, medical grade silicon rubber, and porous polyethylene. The autologous costal cartilage avoids rejection, and has advantages such as good flexibility, easy combination with surrounding coated tissues, and low surgical cost. However, the acquisition causes injury, increases pain of patients, alters thoracic cage structure, and the cartilage graft is absorbable and deformable. The medical grade silicon rubber exhibits good exposure rate and high inflammation, which limit its clinical application. Medpor implant has been used recently as novel medical chemical synthesis materials. It makes of high density polyethylene, with strong plasticity, time-efficacy, stable fusion with local tissue and good biocompatibility. However, the exposure of Medpor implant is the complication. In this study, the Medpor implant in combination with total auricle reconstruction was used to treat 12 cases of congenital microtia, trauma-induced auricular defect, auricular defect complicated by atresia of external auditory canal and hearing disturbance. Postauricular fascial flap was expanded to form reconstructed auricle, followed by wound skingrafting. The expanded fascial flap improves blood supply, with close coating, decreases complications. Moreover, all reconstructed auricle survived, with no ulcerate or exposure, and the appearance is similar to normal auricle.更多还原