【摘要】 目的探讨采用双扩张器重叠埋置瘢痕皮肤扩张法在烧伤后耳廓全缺损修复中的临床应用。方法选取2014年7月～2016年1月烧伤后全耳廓缺损患者18例,采用双扩张器重叠埋置瘢痕皮肤扩张法进行全耳廓再造术,手术分两期进行:一期手术于耳后行扩张器埋置术,在患侧乳突区植入皮肤软组织扩张器80 mL和50 mL各一个;二期手术取出扩张器,在不牵拉耳后皮瓣的情况下适当切除颈部瘢痕,取自体肋软骨雕刻成耳支架,自耳后上方取颞浅筋膜瓣覆盖耳支架后方,耳后创面植以中厚皮片。结果 18例患者术后皮瓣血运良好,无坏死,植皮均成活。随访8～24个月,再造耳廓外形良好,双侧耳基本对称,皮肤色泽红润、感觉正常;移植肋软骨支架无排出、吸收和变形。结论双扩张器重叠埋置瘢痕皮肤扩张法修复烧伤后耳廓全缺损取得了较好的治疗效果,且无明显并发症,是可以作为烧伤后耳廓缺损的治疗方法。更多还原

【Abstract】 Objective To report clinical application of overlapping tissue expansion techniques for skin soft tissue expansion in the treatment of total auricle defect after burn. Methods A total of 18 patients with total auricle defect after burn from July 2014 to January 2016 were enrolled in this study. The overlapping tissue expansion technique consisted of two stages. Stage I involved implantation of two skin soft tissue dilators(50 mL and 80 mL) into subdermal space in the post auricular region over the mastoid. In Stage II, the skin expanders were removed together with removal of scars in the cervical area without disturbing the skin flap behind the ear, which was to be used to cover the framework made of autologous rib cartilage. The wound was covered with medium thickness skin graft. Results The flap and skin graft in all 18 patients maintained good blood supply with no necrosis after operation. At follow ups of 8 to 24 months, the reconstructed ear remained well-formed and essentially symmetrical, and the skin appeared and felt normal. There was no cartilage absorption or deformation. Conclusions Scar skin expansion with autogenous rib cartilage framework for auricle reconstruction produces satisfactory treatment results with no obvious complications. It may be a better treatment for auricular defect after burn.更多还原