颞浅筋膜瓣联合离断耳廓复合移植急诊修复耳廓完全性离断伤

摘要

目的 探讨颞浅筋膜瓣联合离断耳廓组织复合移植在急诊修复耳廓完全性离断伤中的应用及临床效果.方法 2015年6 ～12月,沈阳军区总医院整形科急诊收治6例耳廓大面积完全性离断患者.彻底清创后,将离体耳廓的耳软骨支架与皮肤软组织完整剥离,耳软骨解剖复位,颞浅筋膜瓣带蒂转移覆盖软骨,皮肤修薄成全厚皮片后回植修复.结果 6例患者手术均顺利完成,再植耳均一期愈合.术后1年随访,5例部分耳廓离断患者再造耳廓轮廓明显,颜色与周围皮肤接近一致,颅耳角接近正常,患者及其家属均满意;1例全耳离断患者再造耳廓卷曲挛缩,耳廓缩小、变形,轮廓不明显,外耳道狭窄.结论 利用离断耳廓及颞浅筋膜瓣急诊修复耳廓完全性离断伤,可以一期完成修复,并取得较满意的治疗效果.%Objective To explore the application and effect of superficial temporal fascia flap combined with avulsion auricular tissue in emergency auricular restoration.Methods From June 2015 to December 2015,6 patients with auricular large area complete avulsion were underwent treatment in Department of Plastic Surgery of General Hospital of Shenyang Military.After thorough debridement,the auricular cartilage scaffold of the avlusion ear and skin was completely stripped.The auricular cartilage was repositioned on its anatomical site and subsequently covered by superficial temporal fascia flap.The free skin was stripped as full-thickness graft to cover the surface of reconstructed ear.Results All 6 patients with auricle large area complete avulsion achieved immediate repair under emergency condition.The operations were successfully completed and the ears were healed primarily.The patients were followed-up for one year.Five patients with partial auricular avulsion achieved obvious reconstructed auricle profile.The color of reconstructed ear was close to the surrounding skin and the cranioauricular angle was nearly normal.Patients and their families were very satisfied.One patient of total auricular reconstruction had auricular contracture.The auricle profile was not obvious with small size,morphological changes and external auditory canal stenosis.Conclusions Avulsion auricle and temporal superficial fascia flap can be used to repair partial auricle defects as a first-stage repair with ideal results.It is the best choice for large auricle defects in emergency cases.