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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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Preliminary Marking of Incision Lines (Fig. 6.3)
䊏
Depending on the extent to which the auricle protrudes, a sickleshaped area of skin of appropriate dimensions is marked behind the
auricle. Care should be taken to place the incision line at a safe distance
from the helix (about 1 cm) to facilitate good scar healing. On the dorsalsurfaceoftheearlobe,atriangularlineismarkedtoallowfora
good adaptation of the ear lobe after surgery .
Local Anesthesia (Fig. 6.4)
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About 10 ml of Scandicaine with epinephrine (mepivacaine hydrochloride) 1:200,000 is infiltrated in a fan-shaped pattern on the dorsal surface of the auricle, starting at the retro-auricular fold. An additional
5 ml is infiltrated into the concha from the front. This approach results
in a precise separation of skin and perichondrium and is part of the
surgical preparation. The sensitive branches of the vagus and auriculotemporal nerves may be infiltrated, in addition, in front of the tragus.
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Fig. 6.3
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Fig. 6.4
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Incision (Fig. 6.5)
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With the thumb and index finger of his or her left hand, the surgeon
pulls the auricle vertically upwards. Carefully following the previously
marked dots, he or she makes the incision with a number 15 scalpel.
This incision starts on the dorsal surface of the lobule and continues far
enough cranially that the crura of anthelix will be easily accessible
during the later surgical dissection.
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Fig. 6.5
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Skin Resection (Fig. 6.6–6.7)
䊏
The oval skin flap excised in this manner is now removed with a number 15 blade, taking care to preserve the perichondrium. During this
procedure, the assisting surgeon pulls the edge of the auricle upward
with the long two-pronged hook.
䊏
The remaining one third of the skin flap is now pulled off with the
dissecting scissors.
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Fig. 6.6
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Fig. 6.7
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䊏
Hemostasis is now performed with the electrocoagulation forceps.
(Fig. 6.8)
Exposure of the Dorsal Surface of the Auricular Cartilage (Fig. 6.9)
䊏
This is followed by complete epiperichondral mobilization of the skin
on the dorsal side of the auricle. The edge of the helix and the periosteum of the mastoid bone constitute the ventral and dorsal boundaries,
respectively.
䊏
The posterior auricular muscle is exposed and transected. The posterior
auricular artery, which is encountered at this location, is coagulated or
ligated. Care should be taken to achieve complete undermining of the
dorsal surface of the auricle, i.e., all tissue bridges should be transected.
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Fig. 6.8
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Fig. 6.9
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Preparation of the Auricular Concha
1. Marking with Fine Needles (Fig. 6.10)
䊏
Planning the resection of the auricular concha of auricle should begin
on the ventral surface of the auricle. For this purpose, two or three fine
20-gauge hypodermic needles should be placed along the conchal-anthelix fold at an angle of exactly 90° to the auricular surface. The anterior crus and the antitragus serve as the cranial and caudal anatomical
signposts, respectively. The middle needle is generally placed at the
location of the greatest curvature of the concha.
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2. Marking of Incision Lines (Fig. 6.11)
䊏
The surgeon now inserts the short two-pronged hook with his or her
left hand. Using a sterile marking pen, he or she makes mirror-image
markings on the dorsal side of the area of the concha to be resected.
䊏
After the incision boundaries have been marked, the hypodermic
needles can be removed again.
Fig. 6.10
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Fig. 6.11
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