[Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction].

目的: 探讨全耳再造术中将三维立体力学平衡理念用于软骨支架构建的临床经验及疗效。. 方法: 2015 年 6 月—2017 年 6 月，对 97 例（102 侧）小耳畸形患者应用组织扩张器法行全耳再造。男 43 例，女 54 例；年龄 7～45 岁，平均 14 岁。单侧小耳畸形 92 例，左侧 45 例、右侧 47 例；双侧 5 例。先天性 89 例，继发性 8 例。根据小耳畸形分型标准：Ⅱ型 21 例，Ⅲ型 67 型，Ⅳ型 9 例。一期植入组织扩张器。二期利用自体软骨构建耳支架，并切取皮瓣包裹；按照三维立体力学平衡理念，耳支架以支架底座、耳轮与对耳轮下脚的交汇处、耳轮缘为支撑点，形成稳定三角形结构。三期修整再造耳。. Results: All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period. Conclusion: Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.