小耳畸形重建ppt课件.ppt

小耳畸形,TheNagataTechnique,BackgroundFirstintroducedin1993,theNagatatechniquehasenjoyedwidesuccessasanalternativetotheBrenttechnique.Itsmajoradvantageliesinitstwo-stagedapproach,ThefirststageoftheNagatatechniqueinvolves:FabricationandinsertionofacartilageframeworkTranspositionofthelobuleThisroughlycorrespondstothefirstthreestagesoftheBrenttechnique,FirstStage,Usetheipsilateral6th9thcostalcartilagesinfabricatingtheframework,Harvestingofthecostalcartilages,Theframeworkisconstructedinthreedistinctlevelsor“floors”Firstfloor：thecrushelicis、fossatriangularisSecondfloor：thescaphaThirdfloor:thehelix、antihelix、tragus,antitragus,FabricationThe6thand7thisbaseframeThe8thisthehelixandcrushelicisThe9thisthesuperiorcrus,inferiorcrus、andantihelix,Insertthecartilageframework,1.A“W”incisiononlobuleremnant,2.Theskinflapiselevatedtoreceivetheframework,Bolstersofdentalcottonarethenusedtosecuretheskinflapstothecartilageframework.Theseareaffixedwith4-0monofilamentmattresssutures.Thebolstersarekeptinplacefor2weeks,3.Insertthecartilageframework,SecondStageElevatetheconstruction,SecondStageThetemporoparietalfascialflap,Elevatetheconstruction,Raisingtherotationflapforcoveringtheadditionalcartilagegraftforprotrusionoftheauricle,Flaptranspositionforcoverageofthecochalwallcartilagegraft,Rotationflapcoverscochalwallcartilagegraft.Splitthicknessscapleskingraftcoverstheposterioraspectoftheelevatedauriclebeyondthecochalwallgraft.Donorsiteoftheskingraftcoveredwithvaselinegauze.,Posteriorview.Earlypost-operativeresult(10days).,Lateralview(10days),6monthspost-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35cm，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38ml，每周注水3次50ml扩张器可注水5565ml。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，10d拆线。,第三期,聚乙烯塑胶Me