๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Technique
Technique
The cartilage graft donor site is first scrubbed with antiseptic and then anesthetized. The skin can be incised without a skin excision if a small cartilage graft is to be taken. A single incision with skin hook retraction on the wound edges can allow for adequate dissection of the overlying skin and visualization of the cartilage to be harvested. If a larger cartilage graft is planned, an ellipse of skin over the cartilage graft can first be removed to help visualize the underlying cartilage. The surgical defect is measured, and the cartilage graft is oversized by 10% to 15% relative to the size of the cartilage strut required for structural support in order to have adequate length to tuck the cartilage graft edges into the recipient site.7
The cartilage graft is harvested using a no. 15 blade and is incised through the anterior perichondrium, through the cartilage, and then through the posterior perichondrium, with care taken not to incise through the postauricular skin. The graft is gently lifted using forceps, with care taken not to traumatize the delicate tissue. The cartilage graft can also be separated from the surrounding cartilage using iris or Castroviejo scissors. Thorough hemostasis is achieved at the recipient site. Small pockets are then created under the edges of the recipient skin using blunt dissection with surgical scissors or hemostats to create a space where the graft will be placed to interlock with the wound bed.33
The graft is inserted into the wound bed, and a 5-0 absorbable lassoing suture is placed around the cartilage graft and through the wound bed to anchor the graft in place. If it is not possible to create pockets in the recipient site for the insertion of the edges of the cartilage graft, the edges of the graft can be sutured to the periphery of the wound bed with absorbable sutures. The freestanding cartilage graft is most often covered with an FTSG, transposition flap, or interpolation flap. The cartilage graft may also be left to
heal by second intention with or without delayed grafting. The patient should be counseled that the cartilage graft donor site is likely to be more painful than the recipient site postoperatively due to chondritis of the donor auricular cartilage. Although no formal recommendations exist for antibiotic prophylaxis after cartilage graft placement, many suggest a fluoroquinolone antibiotic to minimize the risk of infection and subsequent graft failure.