最新精编医学专题—小耳畸形重建.ppt

小耳畸形(jīxíng)TheNagataTechniqueThefirststageoftheNagatatechniqueinvolves:FabricationandinsertionofacartilageframeworkTranspositionofthelobuleThisroughlycorrespondstothefirstthreestagesoftheBrenttechnique第四页共二十七页。Usetheipsilateral6th–9thcostalcartilagesinfabricatingtheframeworkHarvestingofthecostalcartilagesTheframeworkisconstructedinthreedistinctlevelsor“floors”Firstfloor：thecrushelicis、fossatriangularisSecondfloor：thescaphaThirdfloor:thehelix、antihelix、tragusantitragusFabricationThe6thand7thisbaseframeThe8thisthehelixandcrushelicisThe9thisthesuperiorcrusinferiorcrus、andantihelixBolstersofdentalcottonarethenusedtosecuretheskinflapstothecartilageframework.Theseareaffixedwith4-0monofilamentmattresssutures.Thebolstersarekeptinplacefor2weeksSecondStageElevatetheconstructionSecondStageThetemporoparietalfascialflapElevatetheconstructionFlaptranspositionforcoverageofthecochalwallcartilagegraftRotationflapcoverscochalwallcartilagegraft.Splitthicknessscapleskingraftcoverstheposterioraspectoftheelevatedauriclebeyondthecochalwallgraft.Donorsiteoftheskingraftcoveredwithvaselinegauze.Lateralview(10days)扩张器植入及注液扩张于耳后发际内1cm处设计(shèjì)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。术后第8天开始(kāishǐ)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。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(jìnɡmiàn)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(ruǎngǔ)支架植入取出扩张器aftertheexpanderwasemovedananteriorlybasedexpandedskinflapwasshapedandanipsilateraltemporoparietalfasciaflapmeasuring10X10cmwasharvested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(yǐnliú)管5d拔除10d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(bāozā)10d拆线。组织(zǔzhī)工程内容(nèiróng)总结