Stage I Otoplasty

The main purpose of auricular angioplasty is to restore the shape of the auricle. Auricular angioplasty can be done in one phase or in stages. In the first stage of auricle formation, the formed auricle bracket is placed under the skin of the auricle, and it is erected to reconstruct the shape of the auricle. The posterior skin defect area is repaired by skin grafting; the staged formation is to divide the operation into two phases: In the first phase, the carved auricle bracket is implanted under the auricle. Treatment of diseases: congenital microtia Indication Congenital microtia, or auricle defects caused by acquired factors, usually older than 16 years old. It can also be carried out before school age, which is conducive to children's normal psychological development. Contraindications Old and infirm are not suitable for surgery, can wear false ears; the surgical area of the skin has acute inflammatory lesions, such as folliculitis, bloated, etc., must be operated after the inflammation has subsided. Preoperative preparation Preoperative photography should be performed before surgery, including head, face, and oblique position of the head, etc., in order to compare with postoperative. X-ray film of the head and face of the face, before surgery, to prepare for the auricle bracket during surgery and to determine the position of the auricle. In order to prevent the mark on the plastic sheet from being erased when disinfecting, apply the tip of the needle according to the shape of the auricle and the distance from the eye, nose and mouth. Then use a small plastic piece to cut the ear with the ear shape. The stent model is used to refer to the use of the auricle stent during surgery. In the case of auricular malformation, the auricle can be determined by the parent's auricle as a model. Preparation and medication according to general anesthesia; shaving the hair in the surgical area, including the skin area (such as the inner thigh) and the rib cartilage; and antibiotics to prevent infection 1d in advance. Surgical procedure 1. Incision: Make a longitudinal incision or a C-shaped incision in front of the deformed auricle, deep into the skin. Exfoliate local residual deformed cartilage. 2. Separation: Separately under the skin of the incision with scissors, and form the skin capsule upwards, backwards and downwards. The size of the skin capsule is suitable for the auricle bracket. 3. Take the costal cartilage: If the external ear canal is formed at the same time, the rib cartilage can be taken by one group of doctors, and the ear part can be operated by the other group. The costal cartilage group is also responsible for engraving the auricle bracket. The costal cartilage is preferably the seventh rib on the right side. It can also take the sixth rib or the eighth rib. The length should be determined according to the size of the auricle. Generally, the cartilage should be cut. It should also include the fusion of some adjacent cartilage. Make an arc-shaped incision along the surface of the 7th rib, deep to the surface of the cartilage, and separate the full length of the cartilage and the adjacent cartilage fusion part to be cut. The cartilage in front of the cartilage should be cut together with the cartilage, and the posterior perichondrium should be combined with the cartilage. Separation remains on the chest wall. 4. Carved auricle bracket: Carve the costal cartilage into an auricle bracket according to the model cut in the shape of the ear before surgery. When forming the ear wheel, use a curette to scrape the groove on the side of the cartilage, and bend it to form the ear wheel. Another cartilage strip can be sutured with a thin steel wire. A layer of cartilage can be sutured at the bottom of the auricle support to increase the thickness of the stent to ensure the necessary height of the auricle erected during the second stage of formation. The engraved auricle support is immersed in the physiological saline solution of gentamicin. . 5. Place the auricle bracket: Place the auricle bracket in the ear capsule, and the height of the upper edge should be flush with the upper edge of the auricle of the ear and 3~5mm, and the upper and the upper part of the bracket should be fixed. On the deep fascia. 6. Place the drainage tube: After the auricle stent is placed and fixed, in order to prevent the blood from collecting the skin and attaching the skin to the cartilage support, a drainage tube should be placed in the skin capsule, and a silicone tube with a diameter of 1 to 2 mm (such as a scalp needle infusion tube) can be placed. In the auricle stent cavity, the drainage tube is taken out from the skin behind the ear, and the external end is connected with a needle for injection, and the incision is sutured. The patient immediately picks up the suction device after returning to the ward and continues to attract for 3 days. Prevent blood from clotting and block this tube. 7. Surgery of the ear pressure bandage: put a small gauze in the triangle nest, the boat-like nest, and then use gauze, bandage pressure bandage, in order to facilitate the skin and auricle bracket to attach and display the shape of the auricle and reduce bleeding. But the pressure must be even to prevent skin necrosis. complication 1. Infection, graft necrosis: Due to lack of disinfection, the surgical procedure should be strictly aseptic. After the auricle cartilage stent is engraved, it should be immersed in physiological saline containing 80,000 U of gentamicin for 15-20 min. Re-implant the skin. 2. The cartilage stent is partially exposed: due to the damaged or too thin skin, the local tension is too large, the compression is too tight or the infection causes local necrosis of the skin to cause the cartilage scaffold to be exposed. Therefore, the skin should be of sufficient size during the separation during surgery, and the protection should be paid attention to when the bandage is applied.