小耳再造的时间 Timing of the Reconstruction

发表者：沈干人已读

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The determinants of when to proceed with ear reconstruction for microtia depend largely on the degree of physiologic development of the ear, the size and development of the costal cartilages, and the potential for peer pressure. In general, 85% of ear development is reached by the age of 3 years.3,23 Ear width will continue to increase through the age of 10 years. The costal cartilages are relatively small until the age of 5–6 years making them impractical for use in the fabrication of an ear framework prior to that time. The growth of the costal cartilages usually parallels the rate of growth of ear cartilage through adolescence. In fabricating a costal cartilage framework for total ear reconstruction, therefore, the size of the framework should be the same as that of the normal ear in older patients or slightly larger in younger patients.27,64,66 In the UnitedStates and Europe, most surgeons prefer to perform the ear reconstruction between the ages of 4 and 6 years, during preschool, completing the reconstruction prior to the child entering fifi rst grade. In Japan, Nagata永田 prefers to defer the ear reconstruction until the age of 10 years or later, when the chest wall is nearly fully developed and a trans-xiphoid circumference of 60 cm or greater has been achieved.25,41–45

小耳再造的时机由耳和肋软骨的的发育状况决定，还有个考虑是同龄人给你施加的心理压力。

一般来说，3岁耳就发育达到成人的85%，但是耳的宽度要继续生长到10岁。

而肋软骨在5~6岁左右还是相对弱小，这个时间的肋软骨去构建耳廓是很勉强的。

英美的医生耳再造的时间略早（可能是英美的孩子个体发育快），著名的耳再造大师日本医生Nagata永田（我2016年到他的医院访问学习过）的时间就倾向于10岁或更大些，我当时在他埼玉医院的病房所见到的基本是个头体格基本相似的孩子们。具体说来，经过剑突的胸围应该达到或超过60厘米。

参考文献：

41. Nagata SA. New method of total reconstruction of the auricle for microtia. Plast Reconstr Surg. 1993;92:187.

42. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part I. Grafting the threedimensional costal cartilage framework for lobuletype microtia. Plast Reconstr Surg. 1994;93:221.

43. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part II. Grafting the threedimensional threedimensional costal cartilage framework for conchatype microtia. Plast Reconstr Surg. 1994;93:231.

44. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part III. Grafting the threedimensionalcostal cartilage framework for small concha-type microtia. Plast Reconstr Surg. 1994;93:243.

45. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part IV. Ear elevation for the constructed auricle. Plast Reconstr Surg. 1994;93:254.

Nagata technique, second stage. Clinical case. () The design for incision lines and harvesting of the ultradelicate split-thickness scalp graft and temporoparietal fascia. () A crescent-shaped costal cartilage block is fabricated from the harvested fifi fth costal cartilage. () The constructed cartilage is undermined and elevated. The cartilage graft is wedged in the postauricular sulcus to create the posterior conchal wall. A temporal parietal fascial flfl ap is then transposed to provide soft tissue coverage over the postauricular surface. The wound is closed with an ultradelicate split-thickness scalp skin graft.

二期手术掀起耳廓，需要切取颞浅筋膜和植皮，而且还需要再次取肋骨做耳廓支撑。创伤大，耳后遗留瘢痕。尤其没有颞浅筋膜作为备用的修复材料。