永田小耳症形成外科クリニックと愉快な仲間たち

愉快な仲間たちの秘密の会話

Nagata Microtia and Reconstructive Plastic Surgery Clinic                                  Satoru Nagata,M.D.,Ph.D.
19/April/2012
1-st stage operation for the lobule type microtia
永田小耳症形成外科クリニック  ・ 永田 悟 
耳垂残存型小耳症の肋軟骨移植術

P1040624.jpg
The preoperative appearance of a lobule type microtia.
耳垂残存型小耳症
P1040625.jpg
The actual outline for the reconstruction of the auricle.
The horizontal line in the center is the Frankfurt Horizontal Line.
Normal anatomical position of the auricle is in red.
肋軟骨移植術の手術デザイン。
P1040626.jpg
The anterior view of the fabricated
3-dimensional costal cartilage frame[3-D frame]
and the paper template.
3次元肋軟骨フレームを作成した。

P1040628.jpg
The posterior view of the fabricated 3-D frame.
3次元肋軟骨の裏面。

P1040630.jpg
The intraoperative appearance with the skin flaps formed
(tragus skin flap, posterior and
anterior skin flaps of the lobule
and the mastoid skin flap).
The remnant auricular cartilage is completely removed.
The area undermined for the skin pocket
exceeds 1 cm outside the margin of the outlined area
for auricular reconstruction.
The inferior portion of the posterior skin flap of the lobule
and a portion of the mastoid skin flap form the subcutaneous pedicle.
皮弁形成および皮下ポケットの作成。

P1040631.jpg
The actual intraoperative appearance after insertion
of the 3-D frame into the skin pocket.
Suction is applied to visualize the contour
of the reconstructed auricle.
The smooth u-shaped configuration
of the incisura intertragica is attained,
and the excessive remnant skin is removed during this stage.
3次元肋軟骨フレームを皮下ポケットに移植して再建された耳介

P1040633.jpg
The actual appearance at the end of the first stage operation
with Bolster sutures.
Suction drains are not used because, with my method,
unlike the Tanzer or Brent method where skin surface area is insufficient,
there is ample and sufficient skin surface area to cover the 3-D frame.
Therefor it is possible to use
the Bolster sutures without the worry of necrosis.
Furthermore,the nurses do not have to change
the vacutainers on an hourly or bi-hourly basis
and the patients are not troubled with the change.
ボルスター縫合固定。












管理者にだけ表示

トラックバックURL↓
http://acrejuvenation.blog71.fc2.com/tb.php/3874-0be92e26