Hyperbaric oxygen alleviates scar adhesion at the base and shortens the time of revascularization of delayed skin flap in rats / 中国组织工程研究

BACKGROUND: Hyperbaric oxygen can improve the survival rate of the flap, but whether hyperbaric oxygen therapy can reduce the scar adhesion between the delayed flap and the base, and shorten the time of delayed flap revascularization have not been documented. OBJECTIVE: To observe the changes of the delayed skin flap and the scar tissue at the base on the back of the rat after hyperbaric oxygen therapy, and to seek a safer and more time-saving method of delayed flap formation. METHODS: This experiment simulated the delayed flap model of the human reconstructed ear on the back of Sprague-Dawley rats. Healthy male Sprague-Dawley rats were randomly divided into two groups: a control group and a hyperbaric oxygen treatment group. In the latter group, the rats were placed in the infant hyperbaric oxygen chamber for hyperbaric oxygen treatment for 5 days after surgery. The blood flow of the flap was recorded preoperatively and daily after surgery. Scar tissue thickness, type I/III collagen ratio, vascular number, vascular diameter and the number of vascular endothelial growth factor-positive cells in the flap were recorded preoperatively and on the 1st, 7th, 14th and 21st days postoperatively. RESULTS AND CONCLUSION: The blood flow of the flaps in both groups decreased significantly on the 1st postoperative day, and then began to increase. The blood flow in the hyperbaric oxygen treatment group was significantly higher than that in the control group on the 1st, 7th, 14th and 21st days postoperatively (P < 0.05). The subcutaneous tissue edema in the hyperbaric oxygen treatment group was slighter than that in the control group, and the tissue inflammatory cell infiltration was less. On the 21st postoperatively day, the thickness of scar tissue adhesion at the base in the hyperbaric oxygen treatment group was smaller than that in the control group (P < 0.05). The ratio of type I/III collagen in the hyperbaric oxygen treatment group was lower than that in the control group (P < 0.05). On the 7th, 14th, and 21st days postoperatively, the number of blood vessels in the hyperbaric oxygen treatment group was higher than that in the control group (P < 0.05). The vascular diameter in the two groups was the smallest on the 1st postoperative day, and the largest on the 14th postoperative day. The vascular diameter in the hyperbaric oxygen treatment group was significantly larger than that in control group on the 1st postoperative day (P < 0.05). The number of vascular endothelial growth factor positive cells in both groups began to increase on the 1st postoperativel day, and reached the maximum value on the 14th postoperative day. The number of vascular endothelial growth factor positive cells in the hyperbaric oxygen treatment group was higher than that in the control group at each observation time point (P < 0.05). To conclude, hyperbaric oxygen can reduce the scar adhesion between delayed skin flap and the basement and increase the blood flow of the delayed flaps in rats. Its mechanism may be related to the promotion of revascularization.

The management of auricular defect using retroauricular flap

Management of auricular defect is still a challenge for reconstructive plastic surgeons. The complexity of anatomy and shape will make the reconstruction complicated. It is also inevitable that choosing the right donor to close the defect that resembles the original contour is one of the success indicators of any ear reconstruction. There are wide selections of techniques for the management of auricular defect. Retroauricular flap is one of the best choices in auricular reconstruction due to its vascular richness, low of failure rate, similarity of tissue contour and the ease of closing the donor-site defect primarily. This article reported three cases of auricular defect with various causes: crushed injury, human bite, and tumor excision. Two stages of surgeries were performed on all three patients. After sufficient debridement, the ear defect is planted beneath retroauriculomastoid dermis. The second stage, three weeks from the first surgery, the donor flap is separated from it host. One week follow up after the second stage surgery, all of the post-operative wounds showed no signs of infection, minimal scar formation and has satisfied aesthetic outcomes. The retroauricular flap has the advantages of simple dissection, low failure rate and has a good shape, texture, color for a very good aesthetic results. This flap may be considered as a good solution in the management of auricular defect and a flap bank for ear reconstruction.

The growth of ear of paediatric subjects in Hong Kong—A timely reconstruction for unilateral microtia / 中华整形外科杂志

Objective@#To establish the local data on the growth of ear in Hong Kong children and provide a reference for the timing of reconstruction in unilateral microtia.@*Methods@#We reviewed case notes of paediatric patients up to 18 years of age who had attended our Ear, Nose and Throat Out-patient Clinic from March to November 2017. We recorded the pinna length of these patients and that of their parents, compared the patients’ ear length against that of their parents, and investigated any discrepancy of pinna.@*Results@#We recruited 226 local individuals (139 males and 87 females). The patients were divided into different age groups. The means of ear length of patients were compared with the mean length of pinna of their parents. Data of boys and girls are analyzed separately. Boys at 7-8 years old achieved 87.33% and 93.54% of their fathers’ and mothers’ ear length respectively. Girls at 7-8 years old achieved 83.00% and 90.80% of their fathers’ and mothers’ ear length respectively. Moreover, the average ratio of the length of left and right ear ratio is 97.3% in all groups of children.@*Conclusions@#In Hong Kong children, at the age of 7-8 the ear approaches the size of normal adult ear and is the feasible age with less asymmetry after reconstruction of the microtia.

Clinical applications of ear reconstruction with Medpor / 中南大学学报(医学版)

Objective:To discuss clinical practice,efficacy and surgical techniques for ear reconstruction with Medpor.Methods:Medpor ear reconstructions were used to treat 19 microtia in 17 patients (including 2 bilateral patients) in Xiangya Hospital,Central South University from January 2011 to December 2015.Reconstructions included 2 patients with one-stage ear reconstruction with temporoparietal fascial flap,2 patients with one-stage operation implanting Medpor directly into skin pocket,and 13 patients with two-stage ear reconstruction.Results:After 1-3 years of follow-up,16 microtia in 14 patients gained ideal appearance.Scaffold exposure occurred in 3 unilateral cases,among which one patient who underwent debridement,removal of superficial exposed scaffold and transposition of local flap to salvage exposure was not significantly influenced,and the other 2 patients' scaffolds were still exposed after repairs and finally removed.One stent was removed at the patient's urging because it induced an exacerbation of periarthritis of the right shoulder.Conclusion:Medpor ear scaffold has advantages,such as easy assembly,good immunologic compatibility,fast vascular ingrowth,simple operation,short operative time and ideal appearance of the reconstructed ear.Medpor is an alternative for microtia repair when patients are unwilling to use autologous rib cartilage or costal cartilages are calcified.However,the relatively high incidence of scaffold exposure reminds us that the indications of Medpor should be taken seriously,and measures to avoid skin necrosis and scaffold exposure should be implemented.Long-term follow-up efficacy needs to be proved.

Remnant ear utilized for the inferior part and lobule reconstruction in microtia patient with fully pre-expansion ear reconstruction technique / 中华整形外科杂志

Objective@#This study aimed to present our clinical experience of the utilization of remnant ear for the inferior part and lobule reconstruction in microtia patient with the fully pre-expansion ear reconstruction technique.@*Methods@#During 2017.01—2018.12, 156 cases of unilateral ear reconstruction were performed. The operation was divided into three stages. Six months after the ear reconstruction, the third stage of the remnant ear utilization was performed. The surgery was planned according to the microtia classification and the remnant morphology.@*Results@#All the patients had no complications. Follow-up period ranged from 7—24 months, and ten months on average. All the patients with typeⅠmicrotia had satisfying results of the inferior part and lobule reconstruction. Sixteen cases of types Ⅱand Ⅲ microtia patients had unfortunate outcomes, because the residual ears were too small to reconstruct the earlobe, and the incisure appeared when remnant and reconstructed ear was connected in cases of severe remnant malposition. The rest of patients were satisfied with the reconstruction.@*Conclusions@#The utilization of the remnant ear based on the types of microtia and the remnant morphology could achieve the satisfying result of reconstruction for most of the microtia patients.

A novel method for costal cartilage framework fabrication in full expansion ear reconstruction technique without skin grafts / 中华整形外科杂志

Objective@#This study aimed to present our clinical experience using a novel method for autologus costal cartilage framework fabricationin fully expansion technique ear reconstruction without skin graft.@*Methods@#During Steptember 2016 to Steptember 2017, autologus costal cartilage framework with expansion technique were performed for 63 patients with microtia. Autologous costal cartilage was stacked up to form the structure and height, the natural appearance of auriculocephalic angle was achieved at the same stage, so the second-stage elevation of ear and postauricular skin graft was unnecessary. The delicate structure of the reconstructed ear and ideal bilateral symmetry were achieved by the optimized cartilage stack-up.@*Results@#Three patients out of total 63 patients had cartilage frame work exposure, and were treated with superficial temporal fascia transfer combined with skin graft. The rest 60 patients had satisfied results. Follow-up ranged from 8 months to 18 months and 12 months follow-up was on average. The novel frame work fabrication method was based on the sufficient full pre-expansion procedure. The ideal structure, bilateral symmetry, and excellent definition of the framework, as well as the natural dorsal appearance of the reconstructed auricular were achieved.@*Conclusions@#The cartilage " stack-up" method is essential for the full expansion without skin grafts ear reconstruction technique. The combination of the cartilage " stack-up" framework fabrication and full pre-expansion provide a well-defined, well-projected and bilateral symmetrical ear.

Oreja de Stahl y su manejo quirúrgico / Stahl ear and its surgical management

RESUMEN Introducción: La oreja de Stahl presenta una baja incidencia, aún en centros especializados de reconstrucción auricular. Se caracteriza por presentar un remanente cartilaginoso anormal que se extiende desde el antihélix hasta el borde del hélix, formando una tercer crura. Caso clínico: Varón de 17 años de edad, con deformidad auricular caracterizada por hipoplasia de la raíz del antihélix y presencia de una tercer crura, que comunica el antihélix al hélix. Se realiza resección de la tercer crura y reconstrucción cartilaginosa del pabellón auricular, logrando una adecuada reconstrucción, con buen resultado estético, sin alteración de tamaño en comparación con la oreja contralateral. Conclusiones: Esta es una rara deformidad auricular, muchas veces subdiagnosticada, incluso en centros especializados. Puede acarrear trastornos y estigmas sociales importantes al paciente. El tratamiento quirúrgico es manejo preferencial, y se centra principalmente en la corrección de la tercer crura.

ABSTRACT Introduction: Stahl's ear presents a low incidence, even in specialized ear reconstruction centers. It is characterized by an abno rmal cartilaginous remnant, extending from the antihelix to the edge of the helix, forming a third crura. Case report: A 17-year-old man presented an ear deformity characterized by hypoplasia of the root of the antihelix and the presence of a third crura, which communicates the antihelix to the helix. A resection of third crura and cartilaginous reconstruction of the auricular pavilion was performed, achieving an adequate reconstruction, with good aesthetic results, without size alteration in comparison to the contralateral ear. Conclusions: Stahl's deformity is a rare ear deformity that can lead to significant social disruption and stigma. Surgical treatment is the preferential option for handling this deformity, and focuses mainly on the correction of the third crura.

Post-Auricular Skin Expansion for Microtia Reconstruction / 昆明医科大学学报

Objective To evaluate the effect of retroauricular skin expansion forthe purpose of ear reconstruction.Methods In this technique called three-stage method:1st soft tissue expander implantation under the skin close to the microtic ear,2nd the autogenous rib cartilage is harvested,the ear framework is prepared and covered with expanded skin.3rd the pseudomeatus,tragus and lobule are formed.Results 50 patients out of 55 patients were satisfied with their result and patients were followed up from 6 months to 2 years and no complain were received,There were few case with minor complication of (Exposure of expander,Deflation or Infection,Exposure of framework,Steel wire extrusion,Hypertrophic scar,Chest wall deformities) and the complications were treated accurately and carefully and patients were discharged after recoveries.Conclusion The three-stage method is very useful in microtia by using costal autogenous rib cartilage.

The External Auricular Reconstruction with Inferior Based Retroauricular Flap Including the Posterior Auricular Artery

PURPOSE: The external ear is a common area of trauma on the body prone to exposure of ultraviolet light, which can lead to skin cancer. Thus, variable techniques have been developed and used for reconstruction of the external ear. The aim of this study is to review the surgical method, its area of application, as well as advantages and pitfalls of reconstruction of the external ear with inferior based retroauricular flaps. MATERIALS AND METHODS: Eight patients underwent external ear reconstruction with inferior based retroauricular flap for external ear defects in our institute from September 2012 to June 2015. According to the area of the defect, patients were classified as middle 1/3 (n=4), inferior 1/3 (n=2), superior auroculo-cephalic sulcus (n=1), and external auditory canal (n=1). RESULTS: All of the flaps survived the operation and there was no marginal necrosis. Mean size of the defect was 2.8×1.8 cm and mean size of the retroauricular flap was 5×2 cm. For insetting of the flap, a subcutaneous tunneling technique was used in 6 cases and rotation without subcutaneous tunneling was used in 2 cases. Transient paresthesia occurred in 3 cases. Two cases recovered within 3 months but one case did not recover until 6 months. CONCLUSION: The inferior based retroauricular flap is an available technique in external ear reconstruction with one stage operation.

Ear reconstruction using autologous rib cartilage ear framework by multi-layer spliced sculpture in microtia patients / 中华医学美学美容杂志

Objective To explore ear reconstruction using autologous rib cartilage ear framework by multi-layer spliced sculpture in microtia patients.Methods From Feb 2010 to May 2011,29 microtia patients were subjected to ear reconstruction using autologous rib cartilage ear framwork by four-layer spliced sculpture.Results In one operation 29 patients achieved 2 cm transverse height of reconstructed ears which were basically coincidence with the normal side.Patents and their families were all satisfied with the results.Follow-up of 3-12 months showed that only 1 case reconstructed-ear height was significantly lower transverse process.Owing to sleeping position,the patient did not protect the reconstructed ear,leading to frequent reconstructed-ear pressure.Conclusions The method of multi-layer spliced sculpture autologous rib cartilage ear reconstruction has good clinical effect.It can make reconstructed ear reach nomal transverse height and avoid the third rib cartilage transplant operation to continue increasing the transvers height.

Application of both over-expanded cutaneous flap and temporal superficial fascia flap in ear reconstruction with Medpor / 中华医学美学美容杂志

Objective To investigate the feasibility and results of the application of both expanded cutaneous flap and temporoparietal fascia flap in total ear reconstruction with Medpor framework.Methods The main procedures consisted of three stages:stage Ⅰ-skin expansion,stage Ⅱ auricle formation that consisted of orientation of Medpor implant and creation of coverage for the implant by both expaned skin flap and temporoparietal fascia flap,and stage Ⅲ-treatment of residual ear and recontruction of auricular lobule. Results Twenty-two ears in 22 unilateral microtia patients were constructed using Medpor implants covered with both expanded cutaneous flap and temporoparietal fascia flap over the last three years,and they were accepted as pleasing by the patients.Conclusions Application of both expanded cutaneous flap and temporoparietal fascia flap can assure no extrusion of Medpor implant in ear reconstruction.Further more,the two layers of transferred tissues will not affect the profile details of the reconstructed ear.And because the skin covering the framework and fascia is derived from frommastoid region,the appearance and profile of the reconstructed auricle is true to nature and close to that of the opposite one.

Two-stage Ear Reconstruction with Canaloplasty in Congenital Microtia

The current authors performed two-stage ear reconstruction of microtia using autogenous costal cartilage combined with canaloplasty of the acoustic meatus in a team approach. In the first stage, lobule transposition, fabrication of the cartilage framework, and implantation of the framework were peformed. In the second stage, elevation of the auricle, cartilage graft for posterior auricular sulcus, coverage with the mastoid fascia flap and skin graft, and concha excavation were performed. The canaloplasty was combined simultaneously in patients with radiologic and audiometric evidence of cochlear function in the second stage. A total of 36 consecutive patients with congenital microtia were treated from 1998 to 2003. Among them, 27 patients(male: 18, female: 9) ranging from 7 to 43 years old were combined with canaloplasty. The follow-up period was one year to 5 years. Thirteen patients exhibited improved hearing over 30 dB PTA(pure tone average), 9 patients below 30 dB, and 5 patients with no improvement. Complications related to the canaloplasty were chronic drainages of the auditory meatus and meatal stenosis. Lobule type deformity combined with the canaloplasty showed higher complications than concha type. Therefore, in the lobule type, meticulous manipulation is necessary to reduce complications after the canaloplasty.

Two Cases of Ear Reconstruction Using Prefabricated Radial Forearm Free Flap

Deformities of the auricular region that have been resulted from burns or other traumatic injuries emotionally devastate the patients and frustrate the surgeons. The surgical procedure for ear reconstruction varies depending upon the quality and quantity of available skin in the auricular region after burns and other facial trauma for the coverage of cartilage framework. Postauricular skin, postauricular fascia, temporoparietal fascia have been used for traumatized ear reconstruction according to the literature. But toral ear reconstruction in the cases of severe trauma like burn or traffic accident is one of the most difficult problems because of its paucity and poor quality of the available skin in the auricular region. The author reports two cases of traumatized ear reconstruction using a prefabricated radial forearm fasciocutaneous free flap made of an autogenous costal cartilage framework. This flap is valuable for the reconstruction of severely traumatized ear when local tissue or other free flaps are improper to select.

The Analgesic Effects of Intercostal Nerve Block in Patients Undergoing Total Ear Reconstruction / 대한마취과학회지

BACKGROUND:Patients usually complain of severe postoperative pain at the rib cartilage recession site after total ear reconstruction surgery. We evaluated the postoperative analgesic effects of an intercostal nerve block (ICNB) in patients undergoing total ear reconstruction. METHODS: We injected normal saline (2 ml/rib space) in the control group (n = 15), and 0.75% ropivacaine (2 ml/rib space) in the ICNB group (n = 15) respectively into the 6th, 7th and 8th intercostal spaces following the induction of general anesthesia for surgery. Mean arterial pressures and heart rates were measured pre-ICNB, post-ICNB, pre-surgical incision, 10, 30 and 60 minutes after incision. Numerical rating scales (NRS: 0 = no pain, 10 = most severe pain) were measured at a postoperative 6, 12, 24, 36 and 48 hours by NRS-resting and NRS-coughing, respectively. RESULTS: Mean arterial pressures and heart rates were significantly more stable (P < 0.05) in the ICNB group at 10, 30 and 60 min after incision, than in the control group. NRS were low in all of the ICNB group throughout the postoperative period versus the control group. CONCLUSIONS: We conclude that ICNB induce stable vital signs during rib recession and has excellent postoperative analgesic effects. Thus, we recommend periop-ICNB for total ear reconstruction surgery for the management of anesthesia and postop-analgesia.

Auricular Reconstruction with Autogenous Rib Cartilage Graft using Tissue Expander after Canaloplasty in Microtia

Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.

AN EXPERIMENTAL STUDY OF AURICULAR CARTILAGE FRAMEWORK FORMATION BY PERICHONDRAL GRAFT AND FLAP

Reconstruction of the auricle is one of the most fastidious fields in plastic and reconstructive facial surgery, because the ear is made up of complex cartilage framework arid its thin skin envelope. Insertion of carved rib cartilage is the most popular method for framework fabrication. But it has some disadvantages such as donor site morbidity, lesser flexibility of rib cartilage, difficulty in carving structure and distortion of cartilage after calving. Furthermore surgeon's talent and sufficient practice are necessary for a satisfactory result. So we introduced the concept of perichondral graft to improve the framework fabrication. In 1972 Skoog and associates reported that free perichondral grafts could be used to produce new cartilage. And several other reports supported the chondrogenesis of free perichondral graft. We molded the human ear using silicone rubbed impression material. And the eat mold was wrapped up in perichodrium of rabbit ear and placed in a subcutaneous pocket in formes of graft and flap. Six and eight weeks later, rabbits were sacrified and the newly formed cartilage framework was harvested. Grossly it showed the same appearance as the human eat and elastic property of normal cartilage. In histologic examination, it showed mature structure of normal cartilage; large lacunae containing spherical chondrocytes surrounded by well defined capsule.

A modified auricular reconstruction with medpor framework for children / 重庆医科大学学报

Objective: To find out a better technique of auricular reconstruction with Medpor framework for children to obtain better appearance of the reconstructed ear.Methods: The reconstructed ear was implanted by Medpor framework,which was covered by temporal superfacial fascia flap with superfacial temporal arteria.Skin flap of leftover ear covered rear of reconstructed ear,full thick skin graft covered one of obverse side,and infra-leftover ear was modified as auricularlobule.Results: Postoperative follow-up was as long as 24 months.All 12 patients obtained better appearance of the reconstructed ears than those of the operation in earlier period.Conclusion: The modified auricular reconstruction would be a better choice for the children with congenital lack of auricle or hypoplasia of auricle.