小耳畸形重建

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1、小耳畸形TheNagataTechniqueBackgroundFirstintroducedin1993,theNagatatechniquehasenjoyedwidesuccessasanalternativetotheBrenttechnique.Itsmajoradvantageliesinitstwo-stagedapproachThefirststageoftheNagatatechniqueinvolves:FabricationandinsertionofacartilageframeworkTransp

2、ositionofthelobuleThisroughlycorrespondstothefirstthreestagesoftheBrenttechniqueFirstStageUsetheipsilateral6th–9thcostalcartilagesinfabricatingtheframeworkHarvestingofthecostalcartilagesTheframeworkisconstructedinthreedistinctlevelsor“floors”Firstfloor：thecrushel

3、icis、fossatriangularisSecondfloor：thescaphaThirdfloor:thehelix、antihelix、tragus,antitragusFabricationThe6thand7thisbaseframeThe8thisthehelixandcrushelicisThe9thisthesuperiorcrus,inferiorcrus、andantihelixInsertthecartilageframework1.A“W”incisiononlobuleremnant2.The

4、skinflapiselevatedtoreceivetheframeworkBolstersofdentalcottonarethenusedtosecuretheskinflapstothecartilageframework.Theseareaffixedwith4-0monofilamentmattresssutures.Thebolstersarekeptinplacefor2weeks3.InsertthecartilageframeworkSecondStageElevatetheconstructionSe

5、condStageThetemporoparietalfascialflapElevatetheconstructionRaisingtherotationflapforcoveringtheadditionalcartilagegraftforprotrusionoftheauricleFlaptranspositionforcoverageofthecochalwallcartilagegraftRotationflapcoverscochalwallcartilagegraft.Splitthicknessscapl

6、eskingraftcoverstheposterioraspectoftheelevatedauriclebeyondthecochalwallgraft.Donorsiteoftheskingraftcoveredwithvaselinegauze.Posteriorview.Earlypost-operativeresult(10days).Lateralview(10days)6monthspost-op扩张器植入及注液扩张于耳后发际内1cm处设计平行于发际切口，长约3～5cm，在颞肌浅筋膜上、胸锁乳突肌腱膜上和残

7、耳软骨与软骨膜问进行潜行分离囊袋．植入扩张器，注射壶植入颈部皮下。扩张器法耳再造第一期术后第8天开始注水．每次注射生理盐水3～8ml，每周注水3次．50ml扩张器可注水55～65ml。注水完毕1-2个月后行耳再造术。2monthsafterthefirstoperation软骨支架制备：切取第6-8肋软骨，根据健耳胶片模型、实际尺寸的患耳片(健耳镜面像)，以及健耳外耳轮到颅侧皮肤的垂直距离尽量整体雕刻耳支架。软骨的拼接用记忆合金丝或细丝线。第二期软骨支架植入取出扩张器aftertheexpanderwasemoved,an

8、anteriorlybasedexpandedskinflapwasshapedandanipsilateraltemporoparietalfasciaflapmeasuring10X10cmwasharvested制作蒂在前面的扩张皮瓣及耳后筋膜瓣祛除扩张皮瓣浅层纤维包膜．使皮肤变薄，将软骨支架置入