摘要：
Objective To introduce our experiences in ear reconstruction with Ba Da Chu Method during the past 10 years, and to summarize the operative skills and key points .Methods Generally, Ba Da Chu Method for ear reconstruction includes 3 stages:Stage 1, skin expansion in mastoid region .Stage 2, auricular reconstruction), consisting of tissue expander removal, earlobe transposition, expanded skin flap and temporal fascia flap formation , autologous costal cartilage harvest , framework fabrication and transplantation , and the wound closure .Stage 3: tragus formation , conchoplasty , and refinement of the reconstructed ear.Results From January, 2006 to December, 2015, we performed 5628 reconstructed ears for 5267 patients with congenital microtia .Follow-up period ranged from 1 to 10 years.Complications in stage 1 included hematoma , infection and expander exposure sporadically arising , which were treated properly and stage2 operations were carried out on time or delayed .5202 (92.4％) reconstructed ears were demonstrated with fine substructure landmarks .236(4.2％) reconstructed ears with poor blood circulation at the margin of skin flap , were cured completely and ended up with acceptable outcomes;108 ( 1.9％) reconstructed ears , manifestedwith mild cartilage framework exposure due to partial necrosis of skin graft , were repaired in stage 3.61 (1.1％) of them with severe exposure , needed additional operations to cover the framework with axial fascial flap immediately .21 ( 0.3％) reconstructed ears lost the normal contour because of cartilage infection , which a secondary operation was needed to repair .The complications of stage 3 occurred rarely , which could be cured in the end .Conclusions Ba Da Chu Method is well adapted to treat congenital microtia , and it is flexible to adjust surgical skills when microtia was combined with other complicated soft tissue deformities or craniofacial bone defects;Satisfactory result were achieved in 92.4％reconstructed ears in this study with fine substructures;During approximate 2-month skin expansion , great attention must be paid to ensure successful expansion , which is based on extensive clinical experiences from doctors, appropriate nursing management from nurses , and careful observation from patients or their families.%目的 回顾近几年本团队采用八大处法进行小耳畸形耳廓再造的经验,总结八大处法耳廓再造的手术方法和手术要点.方法 通常情况下八大处法耳廓再造的方法分为三期.第一期:乳突区皮肤扩张器置入、皮肤扩张;第二期:耳廓再造:扩张器取出、耳垂转位、扩张皮瓣转移、颞筋膜软组织瓣形成、自体肋软骨采集、分根利用法耳支架制作、耳支架移植及创面封闭;第三期:耳屏形成、耳甲腔形成、再造耳形态调整.结果 从2006年1月1日到2015年12月31日我科应用八大处法治疗5267例先天性小耳畸形患者,再造耳廓5628只.随访时间1～10年.一期皮肤扩张手术术后并发症有血肿、感染、扩张器外露,经处理后不影响二期手术.二期5202只耳术后恢复良好(92.4％),具备耳廓的标志性结构;236只耳术后伤口有创面(4.2％),经换药后愈合,耳廓形态未受明显影响;108只小面积支架外露(1.9％),简单缝合伤口后愈合,再造耳外形轻度受损,三期手术时予以弥补;61(1.1％)只耳重度支架外露,采用轴形筋膜瓣修补,再造耳形态得以保全;21只耳支架感染(0.3％),再造耳形态大部丧失,进行了翻修手术.三期手术并发症罕见,主要为伤口延期愈合,经换药后痊愈.结论 八大处法耳廓再造在小耳畸形治疗中适应力强,针对小耳畸形合并的各种复杂畸形及颅面结构异常便于调整手术技巧;本组病例92.4％顺利获得标志性的耳廓结构;皮肤扩张手术及扩张过程需要花费2个月时间,期间医护人员和患者/监护人必须耐心细致的观察、治疗,以确保皮肤的顺利扩张.
