2022年医学专题—小耳畸形重建.ppt

小耳畸形(jxng),第一页，共二十七页。,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,第二页，共二十七页。,The first stage of the Nagata technique involves:Fabrication and insertion of a cartilage frameworkTransposition of the lobuleThis roughly corresponds to the first three stages of the Brent technique,First Stage,第三页，共二十七页。,第四页，共二十七页。,Use the ipsilateral 6th9th costal cartilages in fabricating the framework,第五页，共二十七页。,Harvesting of the costal cartilages,第六页，共二十七页。,The framework is constructed in three distinct levels or“floors”First floor：the crus helicis、fossa triangularisSecond floor：the scaphaThird floor:the helix、antihelix、tragus,antitragus,第七页，共二十七页。,Fabrication The 6th and 7th is base frameThe 8th is the helix and crus helicis The 9th is the superior crus,inferior crus、and antihelix,第八页，共二十七页。,Insert the cartilage framework,1.A“W”incision on lobule remnant,第九页，共二十七页。,2.The skin flap is elevated to receive the framework,第十页，共二十七页。,Bolsters of dental cotton are then used to secure the skinflaps to the cartilage framework.These are affixedwith 4-0 monofilament mattress sutures.The bolstersare kept in place for 2 weeks,3.Insert the cartilage framework,第十一页，共二十七页。,Second StageElevate the construction,第十二页，共二十七页。,Second Stage The temporoparietal fascial flap,第十三页，共二十七页。,Elevate the construction,Raising the rotation flap for covering the additional cartilage graft for protrusion of the auricle,第十四页，共二十七页。,Flap transposition for coverage of the cochal wall cartilage graft,第十五页，共二十七页。,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).,第十六页，共二十七页。,Lateral view(10 days),6 months post-op,第十七页，共二十七页。,扩张器植入及注液扩张于耳后发际内1 cm处设计(shj)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(zizo),第一期,第十八页，共二十七页。,术后第8天开始(kish)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,第十九页，共二十七页。,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(jn min)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,第二十页，共二十七页。,软骨(rung)支架植入取出扩张器,第二十一页，共二十七页。,after the expander was emoved,an anteriorly based expanded skin flap was shaped and an ipsilateraltemporoparietal 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(xinwi)包膜使皮肤变薄，将软骨支架置入皮瓣和筋膜瓣之间固定,第二十二页，共二十七页。,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(ynli)管5 d拔除，1 0 d拆线。,第二十三页，共二十七页。,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(boz)，1 0 d拆线。,第三期,第二十四页，共二十七页。,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(wi l)率是制约Medpor应用的瓶颈。早期的外露(wi l)主要与颞浅筋膜的血供有关，远期外露(wi l)主要与患者自身的保护、护理以及材料本身的因素有关。,第二十五页，共二十七页。,组织(zzh)工程,第二十六页，共二十七页。,内容(nirng)总结,小耳畸形。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。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(gub)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。组织工程,第二十七页，共二十七页。,