小耳畸形重建.pptVIP

小耳畸形;The Nagata Technique;The first stage of the Nagata technique involves : Fabrication and insertion of a cartilage framework Transposition of the lobule This roughly corresponds to the first three stages of the Brent technique;Use the ipsilateral 6th–9th costal cartilages in fabricating the framework;Harvesting of the costal cartilages;The framework is constructed in three distinct levels or “floors” First floor： the crus helicis、fossa triangularis Second floor： the scapha 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; ; ;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;Second StageElevate the construction;Second Stage The temporoparietal fascial flap;Elevate the construction;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.;Lateral view (10 days); 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3～5 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。;术后第8天开始注水．每次注射生理盐水3～8 ml，每周注水3次．50 ml扩张器可注水55～65 ml。注水完毕1-2个月后行耳再造术。 ;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。 ; 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;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。 ;;组织工程