๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Technique
Technique
The recipient wound bed edges are trimmed for a smooth semicircular contour. The donor site is scrubbed with antiseptic and anesthetized. A foil template from suture material provides a suitable three-dimensional material to be drawn and trimmed to the exact size and shape of the surgical defect, erring on the side of oversizing rather than undersizing to account for graft contraction. As with free cartilage grafts, the cartilage portion of the graft may be oversized to fit into grooves created at the periphery of the recipient wound bed. Using the foil template, the donor site on the crus of the ear is traced with a surgical marking pen. A no. 15 scalpel is used to excise the composite graft containing skin, perichondrium, and cartilage, and the graft is briefly placed in a basin of sterile saline. Hemostasis is achieved at the graft recipient site, and the graft is inset into the surgical defect. If the cartilage is oversized for deliberate interlocking into the wound bed, pockets on each side of the recipient are first created with blunt dissection in the same manner as with the freestanding cartilage graft. To achieve a perfect fit, any excess skin or cartilage tissue from the composite graft that does not fit into the defect is trimmed with iris scissors. If a full-thickness alar defect is present, simple interrupted sutures are first placed on the mucosal side of the graft to secure it into place. Then, simple interrupted sutures are placed around the periphery of the skin graft on the epidermal surface. The graft donor site is left to heal by second intention or is repaired with a transposition flap from the immediate postauricular skin.35 As with free cartilage grafts, patients may be treated with fluoroquinolone antibiotics after composite graft repair.