全扩张皮瓣法在小耳畸形矫正中的应用效果探讨(1)
[摘要]目的：探究小耳畸形矫正中应用全扩张皮瓣法的治疗效果。方法：回顾性分析2017年2月-2018年2月在笔者医院进行小耳畸形矫正100例患者资料，均采用全扩张皮瓣法进行小耳畸形矫正。比较患者手术前后小耳情况评分，分析患者治疗效果与术后并发症发生率、美容满意度。结果：患者术后矫正小耳尺寸、色泽、外观、精细结构清晰度以及突出程度评分均高于术前，差异有统计学意义(P<0.05);患者治疗优良率为87.0%，并发症发生率为14.0%，术后患者美容满意度为82.0%;随访半年和1年时恢复正常耳部结构与功能分别有63例(63.0%)与85例(85.0%)，复查结果显示患者再造耳部位结构稳定，各个亚单元结构清晰，同时未见显著瘢痕增存在。结论：小耳畸形矫正中应用全扩张皮瓣法疗效优异，可以显著改善患者小耳畸形状态与外观，术后患者美容满意度高。
[关键词]小耳畸形;全扩张皮瓣法;耳部外观;疗效;美容满意度
[中图分类号]R764.7 [文献标志码]A [文章编号]1008-6455(2020)03-0039-03
Abstract： Objective To explore curative effect of full flap expansion on microtia correction. Methods A retrospective analysis was performed on data of 100 patients undergoing microtia correction in the hospital from February 2017 to February 2018. All patients were treated with full flap expansion for microtia correction. The scores of microtia conditions before and after surgery were compared. The curative effect， incidence of postoperative complications and cosmetic satisfaction were analyzed. Results After surgery， scores of corrected microtia size， color， appearance， definition of fine structure and prominence degree of patients were higher than those before surgery ， the differences were statistically significant (P<0.05). The good rate of treatment and incidence of complications were 87.0% and 14.0%， respectively. The cosmetic satisfaction of patients after surgery was 82.0%. At half a year and a year after follow-up， there were 63 cases(63.0%) and 85 cases(85.0%) with ear structure and function returning to normal. The review results showed that structure of reconstructed ear was stable. The structure of each subunit was clear. There was no significant scar growth. Conclusion The curative effect of full flap expansion is excellent on microtia correction， which can significantly improve stats and appearance of microtia. After surgery， cosmetic satisfaction of patients is high.
Key words： microtia; full flap expansion method; ear appearance; curative effect; cosmetic satisfaction
小耳出現畸形主要由烧伤、肿瘤、先天发育不全以及感染等原因导致，其在我国发生率为0.06%[1]。小耳出现畸形不仅导致患者听力受损，同时耳朵外形异常使患者出现不同程度心理创伤[2]。在临床治疗中整形外科医师一直致力于重建外观和结构接近正常人耳朵耳廓再造耳，临床常用治疗手段为全耳再造术，其主要通过在限定空间重建各种亚单元结构，其后这些亚单元结构又在空间中重现，耳廓独特结构特点要求这种再现必须逼真，同时又要有效减少术后并发症[3]。我国较为成熟耳廓重建手段为全扩张皮瓣法，该法再造耳廓结构稳定，各种亚单元形态接近正常人耳部外观，但是同时也有手术过程繁杂难以短时间熟练掌握等缺点[4]。本研究对笔者医院1年间采用全扩张皮瓣法进行小耳畸形矫正患者相关资料予以总结，以明确全扩张皮瓣法在小耳畸形矫正上的优势，为后期临床大量应用奠定基础。
1 资料和方法
1.1 一般资料：回顾性分析笔者医院2017年2月-2018年2月行小耳畸形矫正术的100例患者的资料。纳入标准：①明确诊断为小耳畸形;②需接受全扩张皮瓣手术，且符合手术指征;③患者相关资料完整。排除标准：①存在全扩张皮瓣手术禁忌证;②采用其他方式如外耳道成形术进行治疗;③曾接受过全扩张皮瓣手术者;④并发高血压、糖尿病等基础疾病;⑤患者体内重要器官存在问题。所有患者均使用全扩张皮瓣法进行小耳畸形矫正，所有患者男57例，女43例;年龄6～34岁，平均(21.83±4.75)岁;小耳畸形程度Ⅰ度、Ⅱ度与Ⅲ度各35例、34例和31例。, http://www.100md.com(王孟佳添 王建春 郑楠)
[关键词]小耳畸形;全扩张皮瓣法;耳部外观;疗效;美容满意度
[中图分类号]R764.7 [文献标志码]A [文章编号]1008-6455(2020)03-0039-03
Abstract： Objective To explore curative effect of full flap expansion on microtia correction. Methods A retrospective analysis was performed on data of 100 patients undergoing microtia correction in the hospital from February 2017 to February 2018. All patients were treated with full flap expansion for microtia correction. The scores of microtia conditions before and after surgery were compared. The curative effect， incidence of postoperative complications and cosmetic satisfaction were analyzed. Results After surgery， scores of corrected microtia size， color， appearance， definition of fine structure and prominence degree of patients were higher than those before surgery ， the differences were statistically significant (P<0.05). The good rate of treatment and incidence of complications were 87.0% and 14.0%， respectively. The cosmetic satisfaction of patients after surgery was 82.0%. At half a year and a year after follow-up， there were 63 cases(63.0%) and 85 cases(85.0%) with ear structure and function returning to normal. The review results showed that structure of reconstructed ear was stable. The structure of each subunit was clear. There was no significant scar growth. Conclusion The curative effect of full flap expansion is excellent on microtia correction， which can significantly improve stats and appearance of microtia. After surgery， cosmetic satisfaction of patients is high.
Key words： microtia; full flap expansion method; ear appearance; curative effect; cosmetic satisfaction
小耳出現畸形主要由烧伤、肿瘤、先天发育不全以及感染等原因导致，其在我国发生率为0.06%[1]。小耳出现畸形不仅导致患者听力受损，同时耳朵外形异常使患者出现不同程度心理创伤[2]。在临床治疗中整形外科医师一直致力于重建外观和结构接近正常人耳朵耳廓再造耳，临床常用治疗手段为全耳再造术，其主要通过在限定空间重建各种亚单元结构，其后这些亚单元结构又在空间中重现，耳廓独特结构特点要求这种再现必须逼真，同时又要有效减少术后并发症[3]。我国较为成熟耳廓重建手段为全扩张皮瓣法，该法再造耳廓结构稳定，各种亚单元形态接近正常人耳部外观，但是同时也有手术过程繁杂难以短时间熟练掌握等缺点[4]。本研究对笔者医院1年间采用全扩张皮瓣法进行小耳畸形矫正患者相关资料予以总结，以明确全扩张皮瓣法在小耳畸形矫正上的优势，为后期临床大量应用奠定基础。
1 资料和方法
1.1 一般资料：回顾性分析笔者医院2017年2月-2018年2月行小耳畸形矫正术的100例患者的资料。纳入标准：①明确诊断为小耳畸形;②需接受全扩张皮瓣手术，且符合手术指征;③患者相关资料完整。排除标准：①存在全扩张皮瓣手术禁忌证;②采用其他方式如外耳道成形术进行治疗;③曾接受过全扩张皮瓣手术者;④并发高血压、糖尿病等基础疾病;⑤患者体内重要器官存在问题。所有患者均使用全扩张皮瓣法进行小耳畸形矫正，所有患者男57例，女43例;年龄6～34岁，平均(21.83±4.75)岁;小耳畸形程度Ⅰ度、Ⅱ度与Ⅲ度各35例、34例和31例。, http://www.100md.com(王孟佳添 王建春 郑楠)