Comparison of temporal muscle fascia and tragal cartilage perichondrium in endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap / Comparação entre fáscia do músculo temporal e pericôndrio de cartilagem tragal na timpanoplastia endoscópica tipo 1 com descolamento limitado do retalho timpanomeatal

Abstract Introduction Elevation of tympanomeatal flap is one of the basic steps of tympanoplasty. A satisfactory level of anatomic and functional success can be achieved by using different grafts with limited tympanomeatal flap elevation. Objectives We aimed to compare the anatomic and functional success of tragal cartilage perichondrium and temporal muscle fascia in cases of endoscopic type 1 tympanoplasty performed with limited tympanomeatal flap elevation. Methods In total, 81 cases (33 females, 48 males, mean age 22.1<±<10.1 years, interval 18-49 years) which underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap were included the present study. All cases were divided into two groups as tragal cartilage perichondrium (group A) and temporal muscle fascia (group B). The comparison of the groups were made considering the pre- and postoperative air-bone gap and the tympanic membrane status. Results There was no statistically significant difference between Group A and Group B in preoperative and in postoperative air-bone gap values (p<=<0.608 and 0.529, respectively). In Group A and B, postoperative air-bone gap values demonstrated significant decrease compared to the preoperative values (p<=<0.0001). Group A and group B did not demonstrate significant differences between postoperative improvements of air-bone gap values (p<=<0.687). Graft retention success was 92.6% in group A while it was 90.0% in group B. There was no statistically significant difference between the groups in terms of graft retention success (p<=<0.166). Conclusion In accordance with the results of this study, we believe that both tragal cartilage perichondrium and temporal muscle fascia, and also in limited tympanomeatal flap elevation in endoscopic tympanoplasty are all eligible for result in safe and successful surgery.

Resumo Introdução O descolamento do retalho timpanomeatal é uma das etapas básicas da timpanoplastia. Um nível satisfatório de sucesso na restauração anatômica e funcional pode ser alcançado com o uso de diferentes enxertos e descolamento limitado do retalho timpanomeatal. Objetivos Comparar os resultados anatômicos e funcionais entre o uso de pericôndrio de cartilagem tragal e de fáscia do músculo temporal em timpanoplastias endoscópicas tipo 1 feitas com descolamento limitado do retalho timpanomeatal. Método Foram incluídos no estudo 81 pacientes (33 mulheres, 48 homens, média de 22,1 ± 10,1 anos, variação de 18-49 anos), submetidos a timpanoplastia endoscópica transcanal tipo 1 com descolamento limitado do retalho timpanomeatal. Todos os casos foram divididos em dois grupos: pericôndrio da cartilagem tragal (grupo A) e fáscia do músculo temporal (grupo B). Na comparação dos grupos consideraram-se o gap aéreo-ósseo, pré e pós-operatório, e a condição da membrana timpânica. Resultados Não houve diferença estatisticamente significante entre os grupos A e B no pré e pós-operatório (p = 0,608 e 0,529, respectivamente). Nos grupos A e B, os valores do gap aéreo-ósseo no pós-operatório demonstraram redução significante em relação aos valores pré-operatórios (p = 0,0001). Os grupos A e B não demonstraram diferenças significantes entre as medidas pré e pós-operatórias dos valores dos gaps (p = 0,687). O sucesso da retenção do enxerto foi de 92,6% no grupo A, enquanto no grupo B foi de 90,0%, não ocorreu diferença estatisticamente significante entre os grupos (p = 0,166). Conclusão De acordo com os resultados deste estudo, acreditamos que tanto o pericôndrio da cartilagem tragal como a fáscia do músculo temporal, usados com descolamento limitado do retalho timpanomeatal na timpanoplastia endoscópica, são elegíveis para uma cirurgia segura e bem-sucedida.

Comparisons of Results of Type 1 Tympanoplasty Using Temporalis Fascia and Tragal Perichondrium: A Prospective Study

Introduction: Type 1 tympanoplasty is one of the commonest operations done by an ENT surgeon. There are a number of choices regarding the graft material that one uses in this operation. Among those, temporalis fascia and tragal perichondrium are the most common. The aim of the study was to compare the results of tympanoplasty between two groups of patients- one using temporalis fascia as the graft material and the other using tragal perichondrium. Material and methods: This prospective study group consisted of 46 patients between the ages of 10 to 49 years. Only patients with dry safe central perforations and pure conductive hearing loss were included. Success was defined as ear-drum closure with no residual perforation. Hearing improvement was defined as air-bone gap less than 10dB. Results: We had included 46 patients in our study. Of them, 23 had tympanoplasty with temporalis fascia and the other 23 had tympanoplasty with tragal perichondrium. Conclusion: The study showed that both temporalis fascia and tragal perichondrium gave more or less the same results with regard to successful drum closure and hearing improvementthere was little to choose between these two

​Outcome Of Type 1 Tympanoplasty With Cartilage-Perichondrium Graft In Comparison With Temporalis Fascia

OBJECTIVE: To compared the outcome of Type 1 tympanoplasty with cartilage-perichondrium graft in comparison with temporalisfascia graft in terms of post-operative graft take-up and hearing results.MATERIALS AND METHODS: A prospective observational study among 80 patients between 15 and 60 years of age satisfyingthe inclusion criteria with complaints of ear discharge and hearing loss due to COM - mucosal type was conducted. Patientswere grouped in two groups of 40 patients each. Group A patients underwent Type 1 tympanoplasty with temporalis fasciaand Group B with cartilage-perichondrium graft. Patients were followed up for graft uptake, hearing improvement and rate offailure are compared for both the grafts. Graft uptake was assessed at the end of the 1st month, 3rd month, and 6th month,and hearing was assessed at the end of the 6th month with pure tone audiometry.RESULTS: Patients with temporalis fascia graft showed a take-up rate of 80% and cartilage-perichondrium graft of 92.5% by6 months. Among the fascia group, graft failure was seen in 20% (8). One patient had failed take-up of graft and four patientsshowed reperforation. In cartilage group, three patients showed failure of take-up of graft during the 1st month. No patient hadreperforation or retraction. Air-bone gap in fascia group showed a closure to 10 dB in 17.5% (7). In the cartilage group, 10 dBin 25% (10 patient s). In our short-term follow-up of 6 months, we found that cartilage-perichondrial graft reduces the chanceof reperforation and retraction even with variation in middle ear pressure due to eustachian tube catarrh. It gives good takeup rate and comparable hearing result as that of the fascia graft. It does not affect the sound conduction when thinned outto appropriate thickness. It is available from the same surgical field and in sufficient quantity for the closure of the TM defect.Cartilage-perichondrium graft for Type 1 tympanoplasty could be a successful replacement for temporalis fascia giving goodresult with neotympanum.

Clinical Efficacy of Endoscopic Tympanoplasty for Large Tympanic Membrane Perforation / 中山大学学报(医学科学版)

@#【Objective】To investigate the clinical efficacy of endoscopic tympanoplasty for chronic suppurative otitis with large tympanic membrane perforation.【Methods】A total of 110 cases（115 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were retrospectively collected from May 2017 to Jan 2019. All cases were performed endoscopic tympanoplasty；including removing tympanic lesions，reconstruction of ossicular chain， and myringoplasty with cartilage and perichondrium complex by underlay technique. At the same time of tympanoplasty ， balloon eustachian tuboplasty（BET）was performed in patients who were diagnosed with eustachian tube dysfunction. The graft success rate，pure tone threshold average（PTA）of speech frequency and the air-bone gap（ABG）were assessed at 3 months after surgery.【Results】The primary graft success rate was 95.7%，and the PTA and ABG were（25.7±11.8）dB HL and（13.8 ± 6.9）dB HL，respectively，which showed significant differences compared with pre- operation conditions （P < 0.001）. Furthermore，29 ears which were diagnosed with eustachian tube dysfunction were treated with BET at the same time of tympanoplasty. Compared with simply tympanoplasty （86 ears），no difference was found in primary graft success rate ，PTA and ABG post-operation（P > 0.05）.【Conclusions】 Endoscopic tympanoplasty is an effective surgery，and the cartilage and perichondrium complex is a reliable repair material for large tympanic membrane perforation ，which are both worthy of clinical promotion. Furthermore ，BET at the same time of tympanoplasty could ensure clinical efficacy for the patients with eustachian tube dysfunction.

Comparative Study Between Tragal Perichondrium And Tragal Cartilage With Perichondrium As Graft Material In Type 1 Underlay Tympanoplasty

Background: Several graft material used in tympanoplasty operation to repair the perforated tympanic membrane. Our aim of this study is to compare the efficacy of tragal perichondrium and tragal cartilage with perichondrium as graft material Matetials and Methods:This study was a prospective one, conducted in Malda Medical College during January 2015 to December 2017, over 60 patients divided in two equal group randomly 30 patients each. One group undergone Tympanoplasty with tragal perichondrium as graft and in the other group we used tragal cartilage with perichondrium as graft material. The data was collected from above patients and statistically analyzed regarding graft taken or rejected and hearing improvement. Results and Analysis: Underlay tympanoplasty with tragal perichondrium as graft show about 86.67% success rate in respect to drum closure and Tragal cartilage with perichondrium show drum closure in about 80%. Post-operative AIR BONE gap improvement also little better in tragal perichondrium group than cartilage with perichondrium group. Conclusion: The study showed that both tragal perichondrium and tragal perichondrium with cartilage are good graft material in respect to drum closure and hearing improvement.

To Compare The Study Of The Effectiveness Of The Use Of Tragal Cartilage With Temporalis Fascia In Tympanoplasty

Background: Hearing is a sense that enables man to establish contact with his fellows via speech to experience life more fully. Deafness in varying degrees of severity is a big impediment to the integration of a person into the social structure. The otologist in the past had not much to offer to hearing handicapped people with chronic middle ear disease. With recent times the advent of the antibiotic era, the operating microscope and modern anesthetics techniques aimed at producing a dry, magnified operating field, have radically altered the outlook. Methods: This Prospective Randomised Comparative Study comprises of patients who were subjected to tympanoplasty for the treatment of chronic suppurative otits media. Each patient was subjected to a detail examination of nose, paranasal sinuses and throat to rule out any focus of infection, which could influence the result of tympanoplasty. 35 Patients were subjected to tympanoplasty with temporalis fascia while the remaining 35 patients underwent with tragal perichondrium in the age group of 15-50 years (males and females both ). Patients with the complaint of discharging ear and decreased hearing were also screened . Results: Majority of the patients preoperatively showed mild to moderate hearing loss.45.7% patients showed upto 20 db air bone gap range, 48.5% patients being in 21-40db air-bone gap and only 5.7% patients is above 40db. Graft take rate was overall 78.5%. Take-rate was 80% with temporalis fascia and 77.1% with tragal perichondrium. In the postoperative hearing analysis, 75.7% of the patients showed air- bone gap upto 20dB. 21.4% of the patients showed air- bone gap in the range of 21-40 Db. Mean improvement in hearing for temporalis fascia was 12.8 db and for tragal perichondrium was 11.4 db. Take rate of graft was not influenced by the size of perforation. Improvement in hearing was also not significantly influenced by the type of graft used. Conclusion: Tympanoplasty is the most effective method for control of the tubotympanic type of CSOM disease and hearing improvement. Both temporalis fascia and tragal perichondrium are excellent graft materials for closure of perforation of tympanic membrane and hearing improvement. Graft uptake rate is good for both with slightly better take rates for temporalis fascia, than tragal perichondrium.Improvement in hearing is not significantly influenced by duration of disease, age or sex of patients site or size of perforation

Application of thin-ribbed cartilage with the perichondrium in correction of secondary cleft lip nasal deformity as lateral crural onlay graft / 中国修复重建外科杂志

Objective: To explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft. Methods: A retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured. Results: All incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no compli cation, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest points of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral points of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation ( P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line ( P<0.05). No thoracic contour change occurred at the costal cartilage donor site. Conclusion: The thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.

The Curative Effects of Frontal-lateral Window Partial Laryngectomy for T1b Glottic Cancinoma Invading Anterior Commissure / 听力学及言语疾病杂志

Objective To explore the efficacy of reserving thyroid cartilage combined with thyroid perichondrium flap to repair the defect of frontal-lateral window partial laryngectomy for T1b glottic cancinoma with anterior commissure involved.Methods From our hospital 22 cases diagnosed as T1b glottic cancer with anterior commissure invaded were treated with frontal-lateral window partial laryngectomy and were repaired by reserving thyroid cartilage combined with flap of thyroid perichondrium.All the patients were followed up for five years.The functions of respiratory and swallowing,voice rehabilitation,ratios of recurrence and survival were observed.Results All the patients succeeded in removing tracheal cannula.The decannulation rate was100％ and the aspiration rate was 0％.The voice functions in patients with postoperative classification (G) were higher than that of preoperative accounted for 86.4％ (19/22),and the same preoperative accounted for 13.6％ (3/22).There were 2 cases with tumor recurrence,one cases with recurrence in situ and one case with cervical lymph node metastasis.The recurrence rate was 9.1％ (2/22) and the 5 year survival rate was 95.5％ (21/22).Conclusion Frontal-lateral window partial laryngectomy reserving thyroid cartilage combined with thyroid perichondrium flap,is suitable for T1b glottic cancinoma invading anterior commissure.It can preserve the laryngeal framework and function relatively integrated with rare laryngeal stenosis and stabble repaired tissue.It also can effectively improve the sound quality and is worthy of clinical promotion.

The Postoperative Outcome of the Cartilage -perichondrium Complex Reconstructed Tympanic Membrane Perforation in Guinea Pig / 听力学及言语疾病杂志

Objective To observe the thickness and histologic changes of cartilage -perichondrium complex (CP) and vascular density changes in perichondrium after repairing perforated eardrum .Methods Forty -five male guinea pigs were randomly divided into three groups ,and were used to create left TM perforation .The left cavum conchae cartilage-perichondrium was immediately used to repair the perforation .The observation time for group A was two weeks ,group B was six weeks and group C was twelve weeks .The thickness of the composite was meas-ured before and after the implantation .The histologic changes of implants and the vascular change in perichondri were observed .Results The healing time for the left ear was 3 .8 ± 0 .84 ,and the right ear 7 .2 ± 0 .84 .The thick-ness of the composite for group A increased by 14 .4% (P0 .05) .Group C decrease by 14 .2% (P<0 .05) .After implantation ,the thickness of cartilage in group C was decreased by 34 .2% compared to that in group A (P<0 .05) .At the 2nd week in post -implantation ,the number of vessels within the unit area of fiber -perichondrium was up to 13 .28 ± 2 .49 ,while the above number reached to 7 .71 ± 2 .49 at the 6th week after implantation .The final histological structure of recon-structed tympanic membrane at the 2nd week and 6th week was composed of squamous epithelial layer ,fibrous -perichondrium layer ,cartilaginous layer and mucous layer .The above histological structure at 12th week was com-posed of squamous epithelial layer ,cartilaginous layer and mucous layer .Conclusion The healing time of the recon-structed tympanic membrane is shorter than the time spent on healing on its own .The thickness of the composite in post-implantation in three groups first increased and then decreased compared to that in pre -implantation .The number of blood vessels of fiber -perichondrium in the reconstructed tympanic membrane first increased and then re-duced .The layers of final histological structure of reconstructed tympanic membrane are similar to those of normal tympanic membrane .From the perspective of histology ,the cartilage-perichondrium composite is the suitable ma-terial for repairing tympanic membrane .

A Comparative Study of Temporalis Fascia versus Tragal Peri-chondrium as Graft in Repair of Tympanic Membrane Perforation

The perforations of the tympanic membrane may be of traumatic origin or due to chronic suppurative otitis media. If the perforations fail to heal conservatively, they require surgical closure. Autologous graft materials have stood the test of time in repairing tympanic membrane perforations. In our tertiary care institution, we conducted a prospective randomised control trial on 20 subjects to evaluate the comparative efficacy of temporalis fascia and tragal perichondrium as grafting material in underlay tympanoplasty. In this study, surgical success was evaluated in terms of intact drum membrane and minimal complications during the follow-up period. Temporalis fascia achieved a graft uptake of 90% and a satisfactory hearing improvement in 76% of the patients with minimal postoperative complications. Tragal perichondrium achieved a success rate of 80% graft uptake and 75% hearing gain. The rates are comparable with no statistical significance of difference between them.

A Case of Autologous Tragal Perichondrium Graft in a Patient with Mooren's Ulcer

PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for an active Mooren's ulcer. CASE SUMMARY: A 49-year-old male was referred to our clinic with Mooren's ulcer in his left eye. On the first visit, the ulcer involved the entire 360 degrees of the peripheral cornea and the visual acuity was 0.04. As the ulcer did not respond to medical treatment and progressed rapidly, the authors decided on surgical treatment. First, the involved cornea and nearby conjunctiva were removed and the defect was successfully reconstructed with autologous tragal perichondrium and allogenic limbal graft. The progression of corneal ulceration ceased after surgery and the patient's symptoms remarkably improved. Additionally, the graft showed rapid vascularization and engraftment within a week. However, as the opacity evolved and progressed to the central cornea, penetrating keratoplasty (PKP) was performed 5 months after the perichondrial graft. There was no rejection and corneal translucency was kept clear with low-dose steroid eye drops until 6 months after PKP without any sign of limbal deficiency. The patient's final best corrected visual acuity was 0.125. CONCLUSIONS: The present study shows that autologous tragal perichondrium graft is an effective method of treatment for active Mooren's ulcer by defect reconstruction and results in survival of the co-transplanted graft as well as maintaining corneal functions.

Autologous Tragal Perichondrium Transplantation: A Novel Approach for the Management of Painful Bullous Keratopathy

PURPOSE: To introduce autologous tragal perichondrium transplantation as a novel surgical modality for the management of intractable symptomatic bullous keratopathy. METHODS: In three eyes of three patients with painful bullous keratopathy, autologous tragal perichondria were transplanted on the corneal surface with the human amniotic membrane transplanted above. We included an additional three eyes of three patients with painful bullous keratopathy who received amniotic membrane transplantation only to serve as controls. Clinical symptom outcomes were assessed using a visual analogue scale at postsurgical months 1, 3, 5, 7, and 9. In addition, transplanted tragal perichondrium and amniotic membrane complex tissue button obtained from one patient who underwent penetrating keratoplasty was evaluated by immunohistochemical analysis of CD34, vimentin, and alcian blue staining. RESULTS: All three patients who underwent autologous tragal perichondrium and human amniotic membrane co-transplantation showed improvements in pain and tearing. However, all three patients in the control group experienced aggravation of tearing and no further improvement of pain 3 months after surgery. In addition, one patient in the control group developed premature degradation of the amniotic membrane. Histopathologic and immunohistochemical analysis showed intact surface epithelization and positive CD34, vimentin and alcian blue staining of transplanted tragal perichondria. CONCLUSIONS: The tragal perichondrium has a high mechanical structural force and high potency due to well-organized epithelization and the presence of mesenchymal stem cells. Autologous tragal perichondrium transplantation may be an effective modality for the management of painful bullous keratopathy.

Efficacy of Autologous Tragal Perichondrium Graft after Proper Antifungal Treatment in Fungal Necrotizing Scleritis

PURPOSE: To compare the efficacy of an autologous tragal perichondrium graft after proper antifungal treatment between 2 cases of fungal necrotizing scleritis. CASE SUMMARY: A 58-year-old female was referred to our clinic with fungal necrotizing scleritis of the left eye which had occurred after pterygium removal. Scleral melting around calcification was observed. After proper treatment with antifungal agents, the authors performed autologous tragal perichondrium graft; however, 3 months after surgery, a necrosis of sclera recurred and the, patient underwent additional treatment with antifungal agents. No complication has been observed up to 3 months postoperatively. A 36-year-old male visited our clinic with ocular pain and decreased visual acuity associated with necrotizing scleritis which occurred after local conjunctival resection. After 4 weeks of antifungal treatments, scleral lesions were stabilized and the authors confirmed negative findings with repetitive fungus smear test. Therapeutic autologous tragal perichondrium graft was performed, and no complication was observed 3 months postoperatively. CONCLUSIONS: When treating a patient with fungal necrotizing scleritis, preoperative antifungal therapy and confirmation of negative findings in repetitive fungus smear test are important. Autologus tragal perichondrium graft accompanied with proper antifungal therapy is an effective treatment of fungal necrotizing scleritis.

Ocular Reconstruction Using Autologous Tragal Perichondrium for a Refractory Necrotizing Scleral Perforation: A Case Report

PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for a necrotizing scleritis case which was refractory to conventional surgery. CASE SUMMARY: A 75-year-old woman was referred to our clinic with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal five years earlier. The patient underwent scleral graft, pericardium graft, and amniotic membrane graft in other clinics; however, necrosis of the sclera progressed. The best corrected visual acuity was 0.06, and choroidal tissue was nearly exposed below the melted pericardium graft in the nasal area. The authors harvested tragal perichondrium from the right ear, and the scleral defect was successfully reconstructed with an autologous tragal perichondium graft. The graft showed rapid epithelization and neovascularization within a week and conjunctivalization after three months. No complications have been observed up to one year after surgery. CONCLUSIONS: Autologous tragal perichondrium graft is an effective treatment to alter necrotized sclera via neovascularization and rapid epithelization in refractory necrotizing scleritis cases.

Volume and Weight Changes of Autologous Costal Cartilage Grafts with and without Perichondrium in Human

Autologous cartilage grafts have become an integral part of aesthetic and reconstructive plastic surgery. However, little objective information is available about the actual quantitative resorption of cartilage in human. This study sought to objectively quantify and compare the resorption of costal cartilage in human. To compare the resorption characteristics of rib cartilage autografts, we harvested rib cartilage grafts from 37 microtia patients. All autografts were implanted subcutaneously on chest and then removed after 6 to 17 months. Graft mass and volume were compared before and after implantion. Rib cartilage grafts with perichondrium averaged 10.8+/-7.4% resorption by volume, On the other hand rib cartilage grafts without perichondrium 25.5+/-6.8%. There was no evidence of necrosis or inflammatory changes. The rib cartilage is the preferred source of autogenous cartilage for auricular reconstruction. Short-term resorption of rib cartilage without perichondrium appears to be higher than with perichondrium. The low resorption of cartilage with perichondrium may be due to in part to cartilage forming capacity of the perichondrium. It remains to be seen whether these differences in resorption persist in the long term.

Multilayer Onlay Cartilage Graft with Perichondrium: Comparing Growth Rate and Strength in a Rabbit Model

Multilayered cartilage graft has been clinically used at tip plasty, total ear reconstruction, and cleft lip nasal deformities. Perichondrial flap or a free perichondrium has been also commonly used for induction of neocartilage. However, the influence of perichondrium on multilayered cartilage graft to strength and growth rate is still unknown. The purpose of this study was to compare the strength and growth rate of different multilayered cartilage graft and to present the most ideal model of multilayered cartilage graft. Twenty New- zealand white rabbit were used. Triple layers of cartilage grafts with various perichondrium were inserted into six separate pockets in paravertebral region of rabbits. The grafts were grossly and microscopically observed on 8 and 16 weeks after grafting. On gross observation, the grafts showed marked enlargement of three layers of cartilage grafts with perichondrium compare with three layers of cartilage grafts without perichondrium In histologic examination, the number of PCNA-labelled cells were significantly high on three layers of cartilage grafts with perichondrium. In conclusion, this study suggested that triple-layer graft of cartilage grafts with perichondrium on the outside of triple-layer graft has strength and an effect on chondrogenetic induction by the perichondrium.

Chondrogenic Effect of Transplanted Type I Collagen Scaffold within Subperichondrial Cartilage Defect

The purpose of this research is to find out the degree of cartilage regeneration by inserting the atelo- collagen scaffold obtained from dermis of a calf on cartilage defect site. Dissection underneath the perichondrium by the periosteal elevator on both side of ears of six New Zealand white rabbits were made to expose the cartilage, leaving pairs of circular holes 3, 6, 9 mm width with punches. One hole was left for a control, and on the other hole atelo-collagen scaffold of the same size was transplanted. In postoperative 1, 2, 4 weeks, the tissues were dyed. The length of long axis of neocartilage was measured through an optical microscope with a 0.1mm graduation at original magnification, x40. In the first and second week, both group showed no sign of cartilage regeneration. In the fourth week, regeneration on marginal portions was observed on all groups and the average values of length of long axis of neocartilage according to defect size were as follows: In the cases with 3mm defect, it was 0.85+/-0.30mm in the control group, and 1.85+/-0.38mm in the graft group; in the cases with 6 mm defect, 1.33+/-0.58mm in the control group, and 2.25+/-0.46mm in the graft group; and in the cases with 9mm defect, 2.33+/-0.77mm in the control group, and 4.47+/-1.39mm in the graft group. This means that the collagen scaffold has an influence on the regeneration of neocartilage. But the relative ratio of the length of neocartilage to cartilage defect size was not significant in the statistics.

Treatment of large-sized auricular nevus through split-thickness skin grafting over perichondrium / 中华医学美学美容杂志

Objective To investigate the effect of treatment for la rg e-sized auricular nevus through split-thickness grafting over perichondrium. Methods In the six cases with large-sized and giant cong enital melanocytic nevi of the auricle, the auricular lesions were radically exc ised in stages, and each time followed by split-thickness skin grafting. The ou tcome was evaluated. Results The grafts completely surviv ed. During the time of follow-up ranging from one to two years, the grafts expe rienced no contraction, and auricular deformity did not occur. Conclu sion Treatment of large-sized auricular nevus through staged split -thickness skin grafting over perichondrium is simple and reliable.

Experimental study on efficacy of perichondrium and an acellular cartilage matrix for generating cartilage / 中国微创外科杂志

Objective To study the possibility of generating cartilage with a free composite graft of perichondrium and matrix. Methods A composite graft of a free perichondrium flap wrapped around acellular auricular cartilage matrix was implanted in the back subcutaneously of young New Zealand rabbits (GroupⅠ). As controls,double folded perichondrium free flap (GroupⅡa) and acellular auricular cartilage matrix without perichondrium cover (GroupⅡb) were implanted. Results 3 weeks and 6 weeks after implantation , obvious differences of chondroblasts derived from the perichondrium were observed between the GroupⅠand GroupⅡa (P