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Objective@#To investigate the effect and safety of ultra-thin oblique posterosuperior auricular fascial flap in the second stage of ear reconstruction.@*Methods@#Fifty-six cases with congenital microtia treated in The Second Affiliated Hospital of Zhengzhou University Medical Cosmetology Department from November 2015 to November 2018 were selected as the research objects. In the first stage, the costal cartilage ear stent was implanted, and in the second stage. The ultra-thin posterior oblique fascia flap was used to cover the stent. And the cranioauricular angle was reconstructed by free skin grafting.@*Results@#48 cases of the 54 cases completely survived, and 8 cases had hemorrhage after operation. The wounds were healed after dressing change. The postoperative cranioauricular angle was close to the healthy side.@*Conclusions@#In the second stage of ear reconstruction, the retroauricular ultra-thin fascial flap method has reliable blood supply, small wound, unswollen reconstructed ears, and good outcome. It is a good choice for covering the ear framework.
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Objective@#To explore a good method for locating reconstructed auricle.@*Methods@#An X-ray film ear template was modelled with the opposite healthy ear, then the template was reversely placed on the malformed side. The position of template was adjusted according to the observation at a standard frontal view and the relations with local anatomic landmarks until bilateral auricular symmetry was reached. At that time the position of template was fixed, and three points were marked. The first point was the most front point of helix, that is in front of the junction of helix and inferion crura of antihelix. The second point was the junction of superior edge of earlobe and tragus. The third point was the junction of inferior edge of the earlobe and face.After marking the three points, the template was placed in flat based on the three points, and the shape of auricle was drawn.Whether the remnant earlobe was dislocated was decided by the difference between the position of remnant earlobe and the marked points.@*Results@#In this study, 118 cases had completed the three stages of ear reconstruction. In the first stage of the operation, 28 cases were residual earlobe moved, 1 case had hematoma postoperatively, and no case had serious complications such as infection and skin flap necrosis.In the second stage of the operation, the position of reconstructed ears were nearly symmetrical to the opposite sides. There were partial necrosis of grafted skins in 2 cases and partial necrosis of skin flaps in 3 cases, which were repaired with simple skin grafting or skin grafting after coverage of superficial temporal fascia flap. In the third stage of the operation, the position of reconstructed auricles was mostly symmetrical to the opposite side, and the wound were healed primarily.The satisfaction rate was 81.4%.@*Conclusions@#Triple-point Marking at a standard frontal view is a simple and practical method for locating reconstructed auricle in ear reconstruction.
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Objective@#To compare the clinical efficacy and patient satisfaction of 755 nm semiconductor laser for hair removal during different stages of auricular reconstruction.@*Methods@#From July 2016 to September 2018, 86 patients who had ear reconstruction underwent 755 nm semiconductor laser for auricle hair removal in plastic surgery department of Tongji hospital affiliated to Tongji medical college of Huazhong university of science and technology. There were 39 males and 47 females with an average age 12 years old(from 6 to 28 years old). 28 cases were left ear, 58 cases were right ear. With random grouping, 40 patients underwent auricle hair removal treatment after posterior ear tissue expander implantation (post-operation of stage Ⅰ depilation group) and 46 patients underwent treatment after auricular reconstruction (post-operation of stage Ⅱ depilation group). Auricle hair removal treatments(pulse width 10-20 ms, wave length 755 nm, spot size 10 mm×15 mm, energy density 4-8 J/cm2) were respectively started at different intervention time. Each treatment time were 5-10 minutes. The end of the treatment was slight redness or edema of the local hairy follicle. The treatment was repeated every 4 weeks with a total of 5 times. The number of adverse reactions was recorded as while as the hair density, hair clearance rate and patient satisfaction before treatment and 6 months after the 5th depilation.@*Results@#Patients in both groups successfully were completed the treatment and were followed up to about 6 months (23 to 25 weeks) after the last depilation treatment. There were only 2 cases with scratch in skin preparation and 2 cases with blisters in the postoperative of stage Ⅱ group. None of the other patients had adverse reactions. Hair density after treatment (27.63±7.75 bar/cm2) was less than before treatment (84.55±13.68 bar/cm2) in post-operation of stage Ⅰ depilation group. Hair density after treatment was 40.52±5.92 bar/cm2 in post-operation of stage Ⅱ depilation group, less than before treatment (74.78±11.19 bar/cm2). The differences were statistically significant (both P<0.001). After hair removal, the hair density of post-treatment in the post-operation of stage Ⅰ depilation group was less than the post-operation of stage Ⅱ depilation group. The difference was statistically significant (P=0.000). The hair clearance rate of the post-operation of stage Ⅰ (67.32%) was higher than the post-operation of stage Ⅱ(45.81%). The difference was statistically significant (P<0.001). Patients’ satisfaction was 87.5% in the post-operation of stage Ⅰ and 69.5% in the post-operation of stage Ⅱ. The former was superior to the latter.@*Conclusions@#Auricle hair removal with semiconductor 755 nm laserstarted at stage Ⅰ that posterior ear tissue expander was implanted has more favorable clinical efficacy, and higher patient’s satisfaction rate.
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Objective@#To explore the clinical effect by using expander implantation immediately to repair the Medpor exposure after ear reconstruction.@*Methods@#From May 2013 to February 2017, 5 patients were treated with ear reconstructive surgery by Medpor implantation. The previous methods contained not only the auricular posterior fascia flap but also skin grafting. Exposed parts were the upper part of the helix and the wounds were dry without purulent secretions. Bacterial culture did not show bacterial growth. Surgical procedure was to remove the Medpor implant and implant a 50 ml kidney expander. When the wound was healed, we started to inject normal saline into the expander. About 3 months later the total volume of normal saline in the expanders were 80-100 ml.Then we could begin the second operation. We removed the expander and harvested the right side of the 7th and 8th rib cartilage, which were carved into the ear cartilage framework and transplanted into the expansion area. The drainage tube, negative pressure and cotton pad appropriate pressure bandage were needed. 6 days later we removed drainage tube.10 days later we removed the suture.@*Results@#The reconstructed external ear shape in five cases were good. No infection occurred. With 6-20 months of follow-up using telephone and WeChat, no obvious deformation of the shape or cartilage exposure occurred. The five patients did not come back to do the third stage operation for financial considerations. They all left their hometown to work out to reduce economic pressure.@*Conclusions@#In the case of ear reconstruction for Medpor prosthesis exposure, if the wounds were not infected, removing the Medpor and transplanting an expander at the same operative stage can achieve a good therapeutic effect.
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Objective@#In order to achieve superior aesthetic outcomes of reconstructed ear, analyze and summarize clinical therapeutic effect in completely applying expanded retroauricular flap to encapsulate cartilage scaffold in total auricular reconstruction.@*Methods@#From January 2016 to October 2017, fifty-three congenital microtia patients were treated. A kidney-shaped tissue expander with 50 ml capacity was embedded under retroauricular skin in the first-stage. After excessive expansion to 70 ml and remaining stable for 4 weeks, secondary operation was performed to completely encapsulate cartilage scaffold with expanded retroauricular skin. Postoperative follow-up was carried out on a routine basis.@*Results@#All patients had undergone operations successfully with primary healing of incision. Blood supply of the retroauricular flaps was excellent, and cartilage scaffolds totally survived with no infection and absorption. Satisfactory aesthetic outcome along with clear structure, reasonable symmetry and suitable auriculocephalic angle was acquired in all cases. No color aberration was observed between the front and back side of reconstructed ear. Scars of retroauricular incisions and costal cartilage harvesting incisions were unconspicuous.@*Conclusions@#Only using expansive retroauricular flap to fully cover reconstructed cartilage scaffold is reasonable and simple without skin grafting, which is worthy of more application in microtia treatment.
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Objective@#To seek an accurate and objective method to locate reconstructed auricles and design frameworks with digital technology for microtia patients with craniomaxillofacial asymmetry, improving the symmetry of the postoperative ears.@*Methods@#From September 2014 to February 2016, 50 unilateral microtia patients with craniomaxillofacial asymmetry who were scheduled for auricular reconstruction were included in the study. The digital models of the patients′ ears and heads were based on the scan data preoperatively, which were collected by the three dimensional(3D) photogrammetric scanning technique. The reconstructed auricle was positioned by the mirror image of the contralateral side on the digital models. Based on the location, the morphological parameters and the corrective parameters of the autogenous cartilage frameworks could be obtained. With the guidance of the above information, ear reconstruction with tissue expander could be carried out.@*Results@#Auricular and craniofacial morphology could be reflected vividly by the digital models. Meanwhile, the location and parameters of the reconstructed ear could be acquired. And the outcomes of the 50 reconstructed ears were satisfactory with symmetrical appearance. With 1 to 8 months (average 6.8 months) of follow-up, both the doctors and the patients were satisfied with the postoperative result.@*Conclusions@#Utilizing the location and parameters which were obtained from the digital models based on 3D photogrammetric scanning is an accurate and objective way to gain more symmetrical result in clinical ear reconstruction for microtia patients with craniomaxillofacial asymmetry.
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Objective@#To explore a 1∶1 2D printing method of rib cartilage based on CT scanning in assisting ear framework fabrication for auricular reconstruction.@*Methods@#From January 2016 to January 2017, 73 cases of microtia aging from 5 to 7 referred to our department. A 1∶1 2D printing of rib cartilage based on CT scanning was applied in preoperative assessment and measurments of bilateral sixth, seventh and eighth costal cartilage were completed before the surgery. Personalized rib cartilage ear framework fabrication was determined by the measurements.@*Results@#Among the 73 cases, 58 cases received auricular reconstruction successfully. There were 15 patients whose rib cartilages did not meet the requirements and postponed the surgery. The patients who underwent auricular reconstruction were followed up for 6 to 12 months (average, 9 months). During the follow-up, 52 cases had satisfactory outcomes in size, shape, symmetry and details. No deformation of reconstructed ears or chest wall was found during the follow-up.@*Conclusions@#The 1∶1 2D printing based on CT scanning is a simple and timesaving way to evaluate the rib cartilage. It can be beneficial to save the amount of cartilage and improve the personalized ear framework fabrication.
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Objective@#To explore the application of asymmetrical sculpture in the ear reconstruction with autologous cartilage through comparing the difference of the balanced sculpture and asymmetrical sculpture.@*Methods@#We used the method of retrospective survey and classified the patients who had undergone ear reconstruction because of microtia into two groups. Group A included the patients who had undergone operation with the application of balanced sculpture method. Group B included the patients who had undergone operation with the application of unsymmetrical sculpture method. We picked out 35 patients containing 19 patients of group A and 16 patients of group B according to our grouping criteria and exclusion criteria. The number of cases with complications was recorded, such as collapse of framework, exposure of cartilage, necrosis of skin flap and reconstructed ear infection. The clinical outcomes of two methods in refining the delicate structures of the reconstructed ear were evaluated (that is the definition, shape, size, color and projection). The time for sculpture was compared. Then we analysed the results and evaluated the effectiveness, safety and feasibility of asymmetrical sculpture′s application in the ear reconstruction.@*Results@#Group A had 2 cases which suffered skin flap necrosis. One of them had cartilage exposure and then had secondary infection leading to local cartilage necrosis and absorption, but after active treatment and local skin flap transplantation it was cured. Group B had no skin flap necrosis, cartilage extrusion, framework deformation and distortion, framework collapse and necrosis or absorption. Group B had a higher score in definition, shape, size, color and projection, and the difference was significant in definition, shape, color and projection. In our clinical practice, the sculpture time in both group was similarly about 40 minutes after the surgery operator had skillfully mastered both techniques.@*Conclusions@#Both methods are safe and feasible. The method of asymmetrical sculpture does not require additional operative time, and the method of asymmetrical sculpture is a better one compared with the method of balanced sculpture in refining the reconstructed ear.
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Objective@#To discuss the strategy for dealing with the failed reconstructed ears.@*Methods@#From January 2010 to January 2015, 14 cases (14 ears) were admitted to our department because of failed reconstructed ears. It was impossible to improve their appearance greatly just by adjusting the original structures. We had to take out the framework and re-reconstruct the ear with autologous costal cartilages. Depending on the conditions of soft tissue, we divided them into three groups: Group 1, 8 ears(57.1%), the soft tissue could be reused simultaneously after being dealt with appropriately although the original frameworks were distorted badly. We took out the original frameworks, harvested cartilages again, fabricated the new frameworks and wrapped them with the original soft tissue. Group 2, 4 ears(28.6%), the structures were damaged completely, just with the constricted scars and skin graft clinging on the mastoid bone. We wrapped the new framework with axial temporal superficial fascia flap and then covered the wound with skin graft; Group 3, 2 ears(14.3%), the structures were distorted seriously. The skin flap covering the framework constricted badly while the post-auricular fascia flap was unspent. We took out the framework, implanted the skin expander under the spread skin flap, and then re-reconstructed the ear with expansion method.@*Results@#13 of 14 cases( 92.9%)were rebuilt successfully. The new ears maintained the landmark subunits 1 month after surgery. In 1 case (7.1%) from group 3, the creased skin had a rupture during skin expansion period. The expander had been taken out, and then a new one was replaced 3 months later. Follow-up period was 3-12 months. The structures of all the 14 rebuilt ears were stable and much better than before.@*Conclusions@#Good results could be achieved when appropriate method was selected for failed reconstructed ear. The condition of soft tissue of distorted reconstructed ear should be considered.
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Since a long time ago, tissue engineering has always been one of our important research fields in ear reconstruction. Professor Yilin Cao et al published their paper＂Transplantation of chondrocytes utilizing a polymer-cell construct to produce tissue-engineered cartilage in the shape of a human ear＂in 1997. Since then, the following studies have made some progress in the areas of seed cell culture and scaffold preparation. Depending on decades of clinical experiences of ear reconstruction with autologous rib cartilage framework, we analyzed the blood supply condition and mechanical properties of the framework after transplantation to the recipient area. And we put forward the idea of harvesting microtia cartilage as the source of seed cells in Stage 1 surgery. Yilin Cao team, in cooperation with us, constructed the tissue-engineered cartilage framework in the shape of patient′s normal ear with seed cells from microtic cartilage and PCL-PGA-PLA compound bioscaffold.We performed the world′s first case of ear reconstruction with tissue-engineered framework in 2014. The surgical method was ear reconstruction with skin expansion. We treated 2 more cases using the same techniques in 2015 and 2016. Since the framework implantation, the first case has been followed up for 43 months, the second 28 months and the third 14 months. We reported the treatment and clinical observations of the three cases in details as follows for clinical reference.
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Objective@#To investigate the value of Multislice computed tomography volume rendering(VR) technique and 3D printing technique in auricular reconstruction.@*Methods@#Six patients were enrolled for auricular reconstruction with costal cartilage, including 5 congenital microtia patients and 1 traumatic auricular defect patient. We harvest the three-dimensional reconstructive data of the contralateral sixth, seventh, eighth and ninth costal cartilage with VR technique. Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format. Preoperative simulation was performed on the models, accordingly, we determined the strategies of costal cartilage harvest and framework fabrication, and operations were performed based on the pre-designed plan.@*Results@#In all 6 patients, the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results, and more scientific than before. The shapes of reconstructed ears were vivid and natural. No complications such as infection, absorption, distortion and chest deformity happened.@*Conclusions@#Through costal cartilage VR and 3D printing technique, we could make more reasonable preoperative design and simulation. The results can be improved with reduced injury, while avoiding the risks of thoracic deformity.
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Objective@#To analyze the clinical features and diagnostic and therapeutic procedure of microtia in Klippel-Feil syndrome(KFS), and to summarize the experiences on diagnosis and treatment of this kind of rare disease to avoid misdiagnosing.@*Methods@#Between May 2014 and July 2015, six patients with microtia were diagnosed with suspected cervical vertebral malformation through physical examination and X-ray. Then they underwent additional examinations to evaluate the degree of deformities and relative risks: pure tone test, chest CT, cervical spine CT, temporal CT, echocardiography and ultrasonic on kidney and ureters. Ear reconstruction was performed with soft tissue skin expander and autogenous rib cartilage framework.@*Results@#The six patients were diagnosed as KFS with microtia, which had different degree of cervical fusion and thoracic vertebral fusion. Some of them had rib deformity, scoliosis, congenital renal malformation and so on. Of 6 patients, scar formation occurred in 1 case after ear reconstruction, whose new ears had good position and appearance at 1 month after stage II. After operation, 6 cases were followed up for 8-20 months (median, 12 months), none of them had nerve injury. Five cases had completed the third stage. All of them were well-healed after one month. Three cases were followed up for 3-11 months, the reconstructed ears had a three-dimensional configuration, and the cranioauricular angle of the reconstructed ears were similar to the opposite ears.@*Conclusions@#The primary step of comprehensive therapy in microtia with KFS is to diagnose definitely. Enhancing perioperative management can reduce surgery-related risks. It is ought to pay attention to nerve injury in a long-term follow-up.
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The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.