Taoyuan, Taiwan; and Saitama, Japan From the Department of Plastic and Reconstructive Surgery and the Craniofacial Center, Chang-Gung Memorial Hospital; Chang-Gung University, Medical College; and Nagata Microtia and Reconstructive Plastic Surgery Clinic.
Plast Reconstr Surg. 2009 Nov;124(5):1477-1485. doi: 10.1097/PRS.0b013e3181babaf9.
Staged auricular reconstruction remains mainstream among the various techniques of microtia reconstruction using autogenous costal cartilage. The initial stage involves fabrication and implantation of the cartilage framework, followed by projection of the reconstructed auricle in the second stage. During the projection stage, the line of incision is usually made close to the helical rim, from the superoanterior margin of the helical rim to the region of the lobule. Generally, a fascial flap is raised and covered over a cartilage block to project the auricle, and a skin graft is inset over the raw surface of the newly created postauricular sulcus.
The authors developed a new refinement for the second-stage auricular projection, whereby the skin cover for the raw surface over the posterior aspect of the auricle and the postauricular sulcus is an ultra-delicate split-thickness skin graft raised in continuity with the full-thickness skin over the anterior aspect of the auricle.
Incorporation of this new technique has minimized the visibility of suture lines and improved the appearance of the superior otobasion. In addition, the dimension of the skin cover required can be designed with greater precision. Postoperative outcomes using this new technique for auricular projection have been more than satisfactory.
More favorable results that carry less surgical stigma can now be achieved in auricular reconstruction using this new modification of Nagata's two-stage method.
在使用自体肋软骨进行小耳畸形重建的各种技术中，分期耳廓再造仍然是主流。初始阶段涉及软骨框架的制作和植入，然后在第二阶段进行再造耳廓的突出。在突出阶段，切口线通常靠近螺旋边缘，从螺旋边缘的前上缘到耳垂区域。通常，提起筋膜瓣并覆盖在软骨块上以突出耳廓，并将皮片插入新创建的耳后沟的原始表面上。
作者对第二期耳廓突出的方法进行了新的改进，即用于覆盖耳廓后表面和耳后沟原始表面的皮肤覆盖物是与耳廓前表面的全厚皮连续提起的极薄的分层皮片。
采用这种新技术可以最大限度地减少缝线的可见度，并改善上耳基底的外观。此外，可以更精确地设计所需的皮肤覆盖物的尺寸。使用这种新技术进行耳廓突出的术后结果非常令人满意。
使用 Nagata 两期法的这种新改良，可以在耳廓重建中实现更有利且手术痕迹更小的结果。
