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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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3. Incision of Conchal Cartilage (Fig. 6.12)
䊏
With his or her left hand, the surgeon now reinserts the roller hook in
the upper edge of the incision and pulls the auricle vertically upwards.
When making the cartilage incision, he or she uses the middle finger of
the same hand as an abutment; this finger is luxated from the ventral
surface of the concha dorsally. This facilitates gentle incision of the cartilage and protects the surgeon from making too deep an incision into
theskinontheventralsurfaceoftheauricle.Thecartilagecannowbe
transected with one stroke of the number 15 blade, i.e., the conchal cartilage is excised along the incision boundary markings.
4. Blunt Cartilage Dissection (Fig. 6.13)
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Subsequently, the cartilage is bluntly dissected from the skin on the
ventral surface of the concha with the dissecting scissors. Should the
skin be accidentally perforated here, the perforation can easily be
closed again with a 6/0 suture.
䊏
The conchal cartilage must be mobilized up to the vicinity of the external ear canal and the crus of helix to achieve good cosmetic results and
prevent unsightly skin layers and folds.
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Fig. 6.12
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Fig. 6.13
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Resection of the Concha (Fig. 6.14)
䊏
Following complete mobilization of the concha, the assisting surgeon
takes over the roller hooks to let the surgeon get a firm broad-based
hold on the conchal cartilage with the Adson- B rown tweezers and pull
it dorsally. This cartilage is then severed at its base with the number 15
blade; all of the conchal cartilage is removed.
䊏
In addition, bridges of connective tissue and, if necessary, tissue from
the posterior auricular muscle are removed so that the conchal pole can
be rotated dorsally, without any tension.
䊏
Several fine corrections are to be made, i.e., the surgeon crushes any
over-hanging cartilage with a delicate hook to prevent sharp transitions.
A distinct lessening of tension is already visible in the auricular cartilage: the ear almost lies back against the mastoid of its own accord.
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Fig. 6.14
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Reshaping the Anthelix (Fig. 6.15–6.22)
䊏
For this purpose, two or three fine hypodermic needles are again
placed at the outer edge of the helix, starting on the ventral surface of
the auricle; these needles stake out the line along which the auricle will
be reshaped.
The positions of the needles depend on the extent of anthelix curvature
desired and the backward realignment of the helix. One needle is
placed in the scapha in the upper third of the auricle; the second needle
is placed caudal to the first in the medial third of the auricle.
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䊏
The surgeon now pulls the roller hook upwards and marks the resection boundaries with a sterile marking pen. Using a number 15 blade,
he or she then makes an arch-shaped incision in the cartilage along the
marking lines without perforating the skin on the ventral surface.
(Fig. 6.16)
Fig. 6.15
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Fig. 6.16
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䊏
After the hypodermic needles have been removed, the anthelix roll
which is to be reshaped is fully mobilized with the dissecting scissors
and the skin of the auricle is completely detached. (Fig. 6.17)
䊏
The result is a totally movable cartilage flap making it possible to
reshape the anthelix without any tension.
Incision and dissection should be strictly subperichondral to prevent
injury to the skin on the ventral surface of the auricle.
(Fig. 6.18)
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Fig. 6.17
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Fig. 6.18
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䊏
To optimize the realignment of the anthelix without any tension, in
addition, a cross-hatching pattern is cut into the front side of the
cartilage with a number 15 blade. During this procedure, the assisting
surgeon holds the auricle upwards with the roller hook. Grasping the
anthelix with the Adson-Brown tweezers, the surgeon now makes many
small cuts to form an arch-shaped and cross-hatched pattern. It is
important to make only superficial cuts here to prevent the formation
of visible cartilage edges. (Fig. 6.19)
䊏
In addition, both the frontal and dorsal sides of the anthelix can now be
thinned and any connective tissue removed. (Fig. 6.20)
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Fig. 6.19
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Fig. 6.20
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