Objective To investigate the methods and effectiveness of ear reconstruction for the microtia patients with craniofacial deformities. Methods Between July 2000 and July 2010, ear reconstruction was performed with tissue expander and autogenous costal cartilages in 1 300 microtia patients with degree II+ hemifacial microsoma, and the clinical data were reviewed and analyzed. There were 722 males and 578 females, aged 5 years and 8 months to 33 years and 5 months (median, 12 years and 2 months). The expander was implanted into the retroauricular region in stage I; ear reconstruction was performed after 3-4 weeks of expansion in stage II; and reconstructed ear reshaping was carried out at 6 months to 1 year after stage II in 1 198 patients. Results Of 1 300 patients, delayed healing occurred in 28 cases after stage II, healing by first intention was obtained in the other 1 272 cases, whose new ears had good position and appearance at 1 month after stage II. After operation, 200 cases were followed up 1-9 years (mean, 3 years). One case had helix loss because of trauma, and 1 case had the new ear loss because of fistula infection. At last follow-up, the effectiveness were excellent in 110 cases, good in 65 cases, and fair in 23 cases with an excellent and good rate of 88.4%. Conclusion It is difficulty in ear reconstruction that the reconstructed ear is symmetrical to the contralateral one in the microtia patients with degree II+ hemifacial microsoma. The key includes the location of new ear, the fabrication of framework, and the utilization of remnant ear.
Objective To discuss the effects of the temporoparietal fascial flap and the postauricular fascial flap as the materials to cover the postauricular-frame during the second stage operation of the total auricular reconstruction Methods From June 2005 to May 2007, the second stage elevation of the reconstructed auricle was performed at 6-10 months after the first stage total auricular reconstruction for 72 cases (left 31, right 41), 47 males and 25 females, aged 5-28 years old (12on average). According to the Nagata’s classification, 56 cases were lobule-type microtia with no external auditory canal, and the other 16 cases were concha-type microtia with external auditory canal (narrow in 9 cases). Homolateral temporoparietal fascial flap was used to cover the postauricular-frame in 29 patients (group A), and the homolateral postauricular fascial flap was used in the other 43 patients (group B). Results All the patients were followed up for 3-22 months. A total of 55 cases had excellent skin flap and fascial flap (22 in group A and 33 in group B). Darker epidermis could be seen in 15 cases (6 in group A and 9 in group B), and it healed within one month after the operation. Two cases (1 in group A and 1 in group B) suffering from partial grafted skin and fascial flap necrosis (lt; 1 cm2) healed by means of coverage of local flap transfer. All the patients’ reconstructed auriculocephal ic angles were close to the normal side. There existed scars of varying degrees at the area of skin graft in both groups: 47 cases had flat scars (19 in group A and 28 in group B); 18 cases had hyperplastic scars (7 in group A and 11 in group B); and 7 cases had severe scars with the auriculocephal ic angles draw-off (3 in group A and 4 in group B). Furthermore, there were obvious scars in temporal region and severe hair thinning at the donor site in group A, but there were no such conditions in group B. At 6 months of follow-up, reduction of the auriculocephal ic angle occurred in 3 cases of group A and obvious in 5 cases of group B (gt; 0.5 cm). Conclusion Both the temporoparietal fascial flap and the postauricular fascial flap can be appl ied to cover the postauricular-framework in the second stage reconstructed ear elevation, with superiority of the latter over the former.
【Abstract】 Objective To summarize different treatments of the residual ear in auricular reconstruction, toinvestigate the reasonable appl ications of the residual ear. Methods From September 2005 to July 2006, 128 patients（79 males, 49 females; aging 5-21 years with an average of 11 years）with unilateral microtia underwent the staged repair. In the patients, there were 44 cases of left-unilaterally microtia and 84 cases of right-unilaterally microtia. The residual ears looked l ike peanut in 56 patients, l ike sausage in 35 patients, l ike boat in 27 patients, and l ike shells in 10 patients. Among all the patients, the external acoustic meatus was normal in 5 patients, stenosis in 11 patients, and atresia in 112 patients. According to auricular developmental condition, the patients were divided into three types: 17 cases of type I, 98 cases of type II, and 13 cases of type III. In the first stage operation, a 50 mL kidney-l iked expander was implanted into post aurem subcutaneous tissue. The residualear whose superior extremity was close to the hair l ine was treated. The middle and superior part of the residual ear was cut. The redundant residual auricular cartilage was removed. In the second stage operation, the inferior part of the cartilage frame was covered by the middle and superior part of the residual ear. According to the location of the residual ear, “V-Y” plasty, “Z”-plasty and reversal of the residual ear were used to correct the location of the residual ear. In the third stage operation, the remained residual ear was used to reconstruct crus of hel ix or cover the wound surface which was resulted from repairing the reconstructed ear. Results The residual ears which were reshaped and transferred had good blood circulation. All residual ears were survival. The wounds healed by first intention. The follow-up for 8-15 months showed that the auricular lobule of the reconstructed ear was turgor vital is and natural. The locations of the reconstructed ear and normal side ear were symmetry. The auricular lobules of the reconstructed ear survived well. The reconstructed crus of hel ix, hel ix, antihel ix and triangular fossawere clear. The results were satisfactory. Conclusion Using residual ear reasonably is an important procedure of successful auricular reconstruction and the symmetry of the reconstructed ear and uninjured side ear.
ObjectiveTo summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction.MethodsBetween June 2015 and June 2017, ninety-seven microtia patients (102 ears) were treated with total ear reconstruction by using tissue expanders. The patients included 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 8 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which were covered by enlarged flap. According to the three-dimensional mechanical equilibrium concept, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation.ResultsAll patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period.ConclusionApplication of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.
ObjectiveTo investigate the accuracy of multi-slice spiral CT (MSCT) scan and image reconstruction technology for measuring morphological parameters of costal cartilages and to evaluate the volume of costal cartilages. MethodsBetween March and August 2013, 75 patients with congenital microtia and scheduled for auricle reconstruction were included in the study. Of 75 patients, there were 49 males and 26 females with a mean age of 8 years and 5 months (range, 5 years and 7 months to 32 years and 7 months) and a mean weight of 29.5 kg (range, 21-82 kg). A Philips Brilliance 64 MSCT machine was used to scan 1st-12th costal cartilages with the parameters based on the age and weight of the patients. All the data were transported to the workstation for reconstructing the image of the costal cartilages with the technique of maximum intensity projection (MIP) and volume rendering technique (VRT). Then the morphologies of costal cartilages were observed through the images on VRT; the width of the costal cartilaginous ends close to ribs (W) and the length of the total cartilage (L) were measured and compared with their counterparts (W' and L') after the costal cartilages were harvested during the processes of auricle reconstructions to analyze consistency between these two sets of data. ResultsThe morphologies of ribs and costal cartilages shown on VRT image got fine sharpness, verisimilitude, and stereoscopic impressions. A total of 192 costal cartilages were examined. The results showed that the widths of the costal cartilaginous ends close to ribs (W) was (9.69±1.67) mm, and W' was (9.73±1.64) mm, showing no significant difference between W and W' (t=-1.800, P=0.073), and interclass correlation coefficient (ICC) test showed Cronbach's α=0.993. The length of the total cartilage (L) was (83.03±23.86) mm, and L' was (81.83±16.43) mm, showing no significant difference between L and L' (t=1.367, P=0.173), and ICC test showed Cronbach's α=0.904. Linear-regression analysis showed L=1.28×L'-21.93 (R2=0.780, F=673.427, P=0.000). The results suggested there was a good consistency between these two sets of data. ConclusionScanning costal cartilages with appropriate parameters and reconstructing the cartilaginous image with MIP is an effective method to measure the width and length of costal cartilage and to estimate costal cartilage volume, which can provide accurate reference for plastic surgery together with reading the morphology from the image on VRT.
ObjectiveTo explore the reasonable utilization of residual ear tissue after total ear reconstruction with total expansion method in patients with microtia of concha cavity, in order to obtain the best appearance.MethodsThe clinical data of 150 patients with microtia of concha cavity between January 2012 and January 2017 were retrospectively analyzed. There were 92 males and 58 females, with an average age of 11.1 years (range, 6.5-35.0 years). The shallow upper auriculocephalic angle was found after the first stage expander embedding and the second stage total expansion, and the third stage auricular reconstruction was carried out 6-12 months later. The residual earlobe was transferred through Z-plasty to reconstruct the lobe. An arc incision was made to release and deepen the upper auriculocephalic angle. And then a skin flap pedicled on the upper part of the residual ear was formed and then transferred to cover the wound on the auriculocephalic angle. The residual ear cartilage tissue flaps with subcutaneous tissue pedicle were inserted into the lacuna under the framework to increase the height of the scaffold. The remaining residual ear skin flaps were sutured to cover the wound of concha.ResultsA epidermis blister in diameter of 0.5 cm was found in 1 patient’s flap at 7 days after operation, and healed after 2 weeks of dressing change. The other patients’ flaps survived well. All the patients were followed up 6-12 months, with an average of 9.6 months. The auriculocephalic angle in the upper part of the reconstructed ear was obviously deepened, the height of the reconstructed ear was increased. The symmetry of the ears was better than before. The concha was not obviously contracted and the appearance of the reconstructed ear was satisfactory. The hair on the upper surface of the reconstructed ear decreased obviously, and the hairline around the ear moved up.ConclusionThe transfer of the upper residual auricular skin flap and residual auricular cartilage in patients with microtia of concha cavity can not only deepen the auriculocephalic angle, but also increase the height of the upper framework. The symmetry between the reconstructed auricle and the normal auricle is better than before.
ObjectiveTo explore the anthropometric changes of the auricle after auricular cartilage unfolding in moderate concha-type microtia patients, so as to provide the basis to help evaluate surgical timing and prognostic.MethodsA total of 33 children with moderate concha-type microtia, who were treated with auricular cartilage unfolding between October 2016 and September 2018 and met the inclusive criteria, were included in the study. There were 24 boys and 9 girls with an average age of 1.4 years (range, 1-3 years). Sixteen cases were left ears and 17 cases were right ears. The follow-up time was 12-23 months (mean, 17.5 months). The affected auricular detailed structures were observed and quantitatively analyzed before operation and at immediate after operation. The width, length, and perimeter of auricle before operation and at immediate after operation and at last follow-up were noted with three dimensional-scanning technology. The normal auricle was noted as control.ResultsThere were (7.5±1.0) and (11.3±0.8) structures of the affected auricle at pre- and post-operation, respectively, showing significant difference between pre- and post-operation (t=23.279, P=0.000). The length, width, and perimeter of the affected auricle constantly increased after operation, and there were significant differences between pre-operation and immediately after operation and between immediately after operation and last follow-up (P<0.05). The differences of length, width, and perimeter of the affected auricle between immediately after operation and last follow-up were (3.13±1.44), (2.44±0.92), and (8.50±3.76) mm, respectively. And the differences of length, width, and perimeter of the normal auricle between pre-operation and last follow-up were (3.16±1.54), (2.35±0.86), and (9.79±4.60) mm, respectively. There was no significant difference in the differences of length, width, and perimeter between the affected auricle and the normal auricle (P>0.05).ConclusionThe auricular cartilage unfolding in treatment of the moderate concha-type microtia can receive more ear structures and increase auricle sizes, which make it possible for free composite tissue transplantation. In addition, the affected and the contralateral normal auricles have a very similar growth rate and it offers the theoretical foundation for the early treatment for moderate concha-type microtia.