耳后局部三角瓣联合残耳软骨拼接在小耳畸形患儿全扩张法耳再造术中的应用

Application of postauricular local triangular flap combined with residual ear cartilage grafting in the total expansion auricular reconstruction for children with microtia

摘要:

目的 探讨在全扩张法耳再造术中，应用耳后局部三角瓣重塑并加深颅耳角、残耳软骨作为功能性填充材料，改善再造耳术后形态的临床效果及安全性。方法 回顾性分析2020年1月—2025年1月湖南省儿童医院收治的25例小耳畸形患儿的临床资料，所有患儿均在标准肋软骨雕刻基础上实施耳后局部三角瓣联合残耳软骨拼接的全扩张法耳再造术。记录患儿肋软骨切取数量、术后形态稳定后的再造耳形态学评分、视觉模拟评分法（VAS）评分及其并发症的发生情况。结果 25例患儿均顺利完成手术。平均切取肋软骨数量为（3.24±0.77）条，无患儿需要切取对侧肋软骨。术后6个月内并发症发生率为8.0%（2/25），经对症处理后均痊愈。术后12~ 18个月随访评估显示，再造耳精细结构显现度评分为（32.48±3.63）分，对称度评分为（4.64±0.86）分，VAS评分为（4.08±0.70）分，满意率（VAS≥4分）为 80.0%。精细结构评分与VAS评分之间呈正相关（ρ=0.72，P<0.001）。结论 在小耳畸形患儿全扩张法耳再造术中，利用耳后局部三角瓣联合残耳软骨拼接耳支架，有助于构建清晰的耳轮脚，获得三维立体感更佳的耳廓，该术式在不增加手术风险的同时可提高患者满意度,具备临床应用价值。

Abstract:

Objective To explore the clinical effect and safety of reshaping and deepening the auriculocephalic angle using the local postauricular triangular flap combined with residual ear cartilage as functional filler in total expansion auricular reconstruction.Methods A retrospective analysis was conducted on the clinical data of 25 children with microtia who received treatment using the postauricular local triangular flap combined with residual ear cartilage on the basis of standard costal cartilage carving in Hunan Children’s Hospital from January 2020 to January 2025. It was recorded for the amount of the removed rib cartilage from the children, the morphological stability score of the ear reconstructive surgery, the Visual Analogue Scale (VAS), and the complications.Results All 25 children successfully completed the surgery. The average number of harvested costal cartilages was (3.24±0.77), and no patient required harvesting contralateral costal cartilage.The incidence of complications within 6 months after surgery was 8.0%(2/25), and all patients recovered after symptomatic treatment. At postoperative 12~18 months,the assessment result showed that the fine structure visualization score was (32.48±3.63), the symmetry score was (4.64±0.86), the VAS score was (4.08±0.70), and the satisfaction rate (VAS ≥4 points) was 80.0%. The fine structure score was positively correlated with the VAS score (ρ=0.72, P< 0.001).Conclusions In total expansion auricular reconstruction for children with microtia, using the posterior auricular triangular flap method combined with residual ear cartilage to assemble the ear framework can help create a more distinct auricular crus and an auricle with better three-dimensional stereoscopic sense. It can improve patient satisfaction without increasing the surgical risk, which has clinical reference value.