小耳畸形重建上课讲义.ppt

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1、小耳畸形重建ThefirststageoftheNagatatechniqueinvolves:FabricationandinsertionofacartilageframeworkTranspositionofthelobuleThisroughlycorrespondstothefirstthreestagesoftheBrenttechniqueFirstStageUsetheipsilateral6th–9thcostalcartilagesinfabricatingtheframeworkHarvestingoftheco

2、stalcartilagesTheframeworkisconstructedinthreedistinctlevelsor“floors”Firstfloor：thecrushelicis、fossatriangularisSecondfloor：thescaphaThirdfloor:thehelix、antihelix、tragus,antitragusFabricationThe6thand7thisbaseframeThe8thisthehelixandcrushelicisThe9thisthesuperiorcrus,in

3、feriorcrus、andantihelixInsertthecartilageframework1.A“W”incisiononlobuleremnant2.TheskinflapiselevatedtoreceivetheframeworkBolstersofdentalcottonarethenusedtosecuretheskinflapstothecartilageframework.Theseareaffixedwith4-0monofilamentmattresssutures.Thebolstersarekeptinp

4、lacefor2weeks3.InsertthecartilageframeworkSecondStageElevatetheconstructionSecondStageThetemporoparietalfascialflapElevatetheconstructionRaisingtherotationflapforcoveringtheadditionalcartilagegraftforprotrusionoftheauricleFlaptranspositionforcoverageofthecochalwallcartil

5、agegraftRotationflapcoverscochalwallcartilagegraft.Splitthicknessscapleskingraftcoverstheposterioraspectoftheelevatedauriclebeyondthecochalwallgraft.Donorsiteoftheskingraftcoveredwithvaselinegauze.Posteriorview.Earlypost-operativeresult(10days).Lateralview(10days)6months

6、post-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

7、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,ananteriorlybasedexpandedskinflapwasshapedandanipsilateraltemporoparietalfasciaflapmeasuring10X10cmwasharvested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，将软骨支架置入皮瓣和筋膜瓣之间固定残耳向后下转位形成耳垂.支架的前面覆盖扩张皮瓣。耳后创面植皮，打包包扎，负压引流管5d拔除，10d拆线。耳

8、甲腔成形及部分残畸软骨切除耳再造4个月后，于耳甲腔处设计一“C”型皮瓣向前推进折叠形成耳屏，切除残畸软骨及多余的软组织．修整高起的残耳皮肤，尽量带蒂转移覆盖耳甲腔．去除耳甲腔内多余的软组织，直达乳突表面。创