Objective To investigate the application of artificial bone and retroauricular fascial flap in elevation of the auricle which is reconstructed with Nagata method. Methods From June 2010 to June 2015, total auricle reconstruction was performed in 42 patients with congenital microtia. The first stage operation was performed according to the Nagata's method, which involved obtaining contralateral 6, 7 and 8 costal cartilages to fabricate auricle framework and implantation of the costal cartilage framework. The second stage operation was the reconstructed auricle elevation, which was performed 6 months later. Skin incision was made 5mm outside of the posterior margin of the auricle, dissection was performed just beneath the framework and above the fascial plane. The reconstructed auricle framework was separated from the under lying bed. A curved artificial bone was implanted to the posterior wall of the concha to get the same cephaloauricular angle as the contralateral ear, the cephaloauricular angle of the bilateral microtia was designed 30-45 degrees. The retroauricular fascial flap was harvested to wrap the artificial bone and the reconstructed auricle framework. Then, the split-thickness scalp skin was harvested and grafted on the fascia surface. The skin graft was fixed with a tie-over compression dressing of wet gauze. Results After the second stage operation, epidermis blisters were found in 4 cases, which healed well after extracting bubble liquid and changing dressing regularly. Partial retroauricular fascial flap necrosis occurred in 1 case which lead to auricle framework exposure. It was repaired by superficial temporal fascia flap and skin graft. The patients were followed up for 6-24 months, with an average of 15 months. The cephaloauricular angles of the 39 patients were satisfactory. 3 patients had serious skin and scar contracture, which affected the angle and shape of the cephaloauricular angle. Conclusion The application of artificial bone and retroauricular fascial flap in elevation of the reconstructed auricle can provide satisfactory cephaloauricular angle structure, and avoids excessive resection of costal cartilage and excessive thorax trauma.%目的:探讨人工骨与耳后筋膜在先天性小耳畸形Nagata法耳廓再造颅耳角成形术中的应用及临床效果.方法:2010年6月至2015年6月,笔者科室对42例先天性小耳畸形患者进行全耳廓再造.按照Nagata法完成一期耳廓再造手术,即切取对侧的6、7、8肋软骨进行耳支架成形并移植.一期术后6个月行二期颅耳角成形术,在再造耳廓耳轮外5mm切开达耳后筋膜浅层,向耳甲腔方向分离并掀起耳支架;以弧形人工骨支架支撑于再造耳廓支架后方,使再造耳的颅耳角角度与健侧耳相同,双侧小耳畸形者颅耳角达30°~45°;分离耳后筋膜包裹再造耳支架及人工骨支架,切取薄中厚头皮皮片移植于耳后筋膜表面,堆包加压固定.结果:二期术后,4例患者皮片表面起水疱,抽取疱液,经换药处理后愈合良好;1例患者耳后筋膜瓣近耳轮部分坏死,耳支架外露,应用颞浅筋膜瓣覆盖及皮片移植修复.本组患者术后随访6~24个月,平均15个月,39例患者术后颅耳角形态满意;3例患者术后颅耳角皮片及瘢痕挛缩较明显,影响颅耳角角度及形态.结论:应用人工骨与耳后筋膜进行颅耳角成形术可呈现满意的颅耳角结构,且可以避免切取过多的肋软骨对胸廓造成损伤.
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