ABSTRACT
To present our experience with autogenous costal cartilage graft for the reconstruction of a congenital absent ear [Microtia]. Between January 1999 and January 2009, we operated upon 65 patients [75 ears] of total auricular repair using autogenous costal cartilage grafts. There were 40 [61.5%] males and 25 [38.5%] females. The mean age at first operation was 13.3 [7-30] years and the median age was 12.5 years. Six patients were secondary to failed previous reconstructions. The type of microtia was typical in 42 patients [64.6%] and atypical in 23 patients [35.4%]. Regarding the site of microtia; 17 [26.1%] were left sided, 38 [58.5%] were right sided and 10 [15.4%] were bilateral. Fourteen patients [21.5%] had facial asymmetry and 16 patients [24.6%] were syndromic [facial cleft in one case, ipsilateral hemifacial cleft in 7 cases, bilateral hemifacial cleft in 2 cases, contralateral hemifacial cleft in one case, mobius syndrome in two cases and Goldenhar syndrome in one case]. A Temporoparietal fascial flap was needed in 5 ear reconstructions [6.7%]. A subjective scale from 1 to 4 based on size, definition, projection and symmetry of the reconstructed ears was used to record both patients' and surgeon's satisfaction with the overall final result [very good 4, good 3, acceptable 2, poor 1]. For bilateral cases the average score for both ears was recorded. A simple descriptive statistics [mean, percentage] were used to present our results. The overall complication rate was 18.7% [14 ear reconstruction]. Complete loss of the frame occurred in two reconstructions [2.7%] which required redo surgery that gave a better result. Other minor complications included: pneumothorax, keloid scar, and large frame, partial loss of frame, partial skin necrosis and minor wound dehiscence that occurred in 2 reconstructions. Patient's and family satisfaction was very good in 17 patients [26.2%], good in 33 patients [50.8%], acceptable in 14 patients [21.5%] and poor in one patients [1.5%], and Surgeon's satisfaction was very good in 20 patients [30.8%], good in 27 patients[41.5%], acceptable in 13 patients [20%] and poor in 5 patients [7.7%].Total auricular reconstruction is one of the most challenging and demanding subjects in reconstructive surgery, dynamic field with a lot of controversy and long time learning curve; it requires carefully selected staged technique with accurate artistic procedures and creativity. Auricular reconstruction using autologous costal cartilages is an excellent technique that produces the most stable clinical results. Consistently good results are associated with progressive experience. There was no major morbidity, with a good satisfaction for both the patient and surgeon
ABSTRACT
To investigate our experience with "Neck Advancement" as a useful technique in late reconstruction of some neck and lower face post-bum scars in addition to evaluate the limitations and complications of this technique. During the period between 1999-2006. A total of 110 "Neck Advancement" procedures were performed on 57 patients with mild to moderate neck and lower face scars at the Royal Jordanian Rehabilitation Center. Forty one of these 57 patients had previous scar revisions or serial excisions ranging from 1-6 procedures per patient prior to the neck advancement. The medical records, pre- and postoperative photographs of these patients were retrospectively studied in terms of age, gender, cause of bum, duration since the acute burn, previous attempts at reconstruction, indications for surgery, results, and postoperative complications. The range of neck advancements was 1-4 procedures per patient. The overall post operative improvement was good in 45 [79%] patients, satisfactory in 9 [16%] patients, and poor in only 3 [5%] patients. There were a total of 13 complications among our group of patients. Apart from simple wound problems related to this technique, the main complication was facial or neck asymmetry, a pseudo-torticollis that tends to occur with unilateral advancements. We found this technique useful in the late reconstruction of a large number of patients with mild to moderate facial and neck bums. It is easy, quick, repeatable and convenient to the patient with a low frequency of complications. It is an additional technique to the armamentarium of the reconstructive surgeon to deal with such difficult burns. It has limitations and is not suitable for the more extensive neck bums