Medpor耳支架全耳再造术的临床应用

摘要

目的:探讨应用Medpor人工耳支架全耳再造的手术方式、临床疗效及支架外露的处理方法.方法:2011年1月至2015年12月在中南大学湘雅医院整形美容科应用Medpor人工耳支架全耳再造术治疗17例先天性小耳畸形患者(包括2例双侧小耳畸形,共19只患耳).采用颞浅筋膜瓣一次性全耳再造2例、皮囊下支架植入法一次性全耳再造2例和分期法全耳再造13例.结果:17例患者随访1～3年,其中14例(共16只患耳)全耳再造患者获得理想外形.3例发生支架外露,其中1例经扩创、外露支架表层削除及局部皮瓣转移得到修复,未明显影响外形;2例多次修复支架仍外露遂最终摘除支架.1例患者全耳再造术后因诱发右侧肩周炎加重,患者强烈要求而摘除支架.结论:Medpor耳支架具有组装较容易、组织相容性好、血管易长人、操作简便、手术省时、创伤较小、再造耳外形理想等优点;可作为不愿切取自体肋软骨或肋软骨严重钙化的小耳畸形患者的替代选择,但支架外露的发生率较高及有手术失败的风险,应严格掌握适应证,防止皮肤坏死、支架外露,远期疗效有待进一步观察.%Objective:To discuss clinical practice,efficacy and surgical techniques for ear reconstruction with Medpor.Methods:Medpor ear reconstructions were used to treat 19 microtia in 17 patients (including 2 bilateral patients) in Xiangya Hospital,Central South University from January 2011 to December 2015.Reconstructions included 2 patients with one-stage ear reconstruction with temporoparietal fascial flap,2 patients with one-stage operation implanting Medpor directly into skin pocket,and 13 patients with two-stage ear reconstruction.Results:After 1-3 years of follow-up,16 microtia in 14 patients gained ideal appearance.Scaffold exposure occurred in 3 unilateral cases,among which one patient who underwent debridement,removal of superficial exposed scaffold and transposition of local flap to salvage exposure was not significantly influenced,and the other 2 patients' scaffolds were still exposed after repairs and finally removed.One stent was removed at the patient's urging because it induced an exacerbation of periarthritis of the right shoulder.Conclusion:Medpor ear scaffold has advantages,such as easy assembly,good immunologic compatibility,fast vascular ingrowth,simple operation,short operative time and ideal appearance of the reconstructed ear.Medpor is an alternative for microtia repair when patients are unwilling to use autologous rib cartilage or costal cartilages are calcified.However,the relatively high incidence of scaffold exposure reminds us that the indications of Medpor should be taken seriously,and measures to avoid skin necrosis and scaffold exposure should be implemented.Long-term follow-up efficacy needs to be proved.