小耳畸形重建.ppt

小耳畸形 The Nagata Technique Background First introduced in 1993,the Nagata technique has enjoyed wide success as an alternative to the Brent technique.Its major advantage lies in its two-staged approach The first stage of the Nagata technique involves:1.Fabrication and insertion of a cartilage framework 2.Transposition of the lobule This roughly corresponds to the first three stages of the Brent technique First Stage Use the ipsilateral 6th9th costal cartilages in fabricating the framework Harvesting of the costal cartilages The framework is constructed in three distinct levels or“floors”1.First floor：the crus helicis、fossa triangularis 2.Second floor：the scapha 3.Third floor:the helix、antihelix、tragus,antitragus Fabrication The 6th and 7th is base frame The 8th is the helix and crus helicis The 9th is the superior crus,inferior crus、and antihelix Insert the cartilage framework 1.A“W”incision on lobule remnant 2.The skin flap is elevated to receive the framework Bolsters of dental cotton are then used to secure the skin flaps to the cartilage framework.These are affixed with 4-0 monofilament mattress sutures.The bolsters are kept in place for 2 weeks 3.Insert the cartilage framework Second Stage Elevate the construction Second Stage The temporoparietal fascial flap Elevate the construction Raising the rotation flap for covering the additional cartilage graft for protrusion of the auricle Flap transposition for coverage of the cochal wall cartilage graft Rotation flap covers cochal wall cartilage graft.Split thickness scaple skin graft covers the posterior aspect of the elevated auricle beyond the cochal wall graft.Donor site of the skin graft covered with vaseline gauze.Posterior view.Early post-operative result(10 days).Lateral view (10 days)6 months post-op 扩张器植入及注液扩张于耳后发际内1 cm处设计平行于发际切口，长约35 cm，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 第一期第一期 术后第8天开始注水每次注射生理盐水38 ml，每周注水3次50 ml扩张器可注水5565 ml。注水完毕1-2个月后行耳再造术。2 months after the first operation 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。第二期第二期 软骨支架植入取出扩张器 after the expander was emoved,an anteriorly based expanded skin flap was shaped and an ipsilateral temporoparietal fascia flap measuring 10X10 cm was harvested 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5 d拔除，1 0 d拆线。耳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。创面植皮，打包包扎，1 0 d拆线。第三期第三期 聚乙烯塑胶Medpor 其优点除了可以避免切取肋软骨造成的创伤外，还可以规避术者雕刻技术欠佳的弱点，但高外露率是制约Medpor应用的瓶颈。早期的外露主要与颞浅筋膜的血供有关，远期外露主要与患者自身的保护、护理以及材料本身的因素有关。组织工程