Reconstrucción mamaria con el uso expansores tisulares / Breast reconstruction with the use of tissue expanders

RESUMEN Introducción: La reconstrucción mamaria por cáncer, mediante la técnica de expansión tisular es una técnica que proporciona piel de color, textura y sensibilidad naturales. Objetivo: Caracterizar la reconstrucción mamaria con el uso de expansores tisulares en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio retrospectivo y longitudinal en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de Cuba del 2013 al 2017. La muestra de 93 pacientes se seleccionó de forma consecutiva del universo de pacientes. El análisis estadístico incluyó las pruebas de Chi-cuadrado, estimación de la razón de momios y regresión logística binaria, con nivel de significación p ≤ 0,05. Resultados: Predominó la reconstrucción en mujeres con un promedio de edad de 45,7 años, [IC95 por ciento (43,8-47,5) y desviación estándar 9.0]. La quimioterapia se administró a 74 pacientes y la radioterapia a 41. La reconstrucción diferida se realizó en el 51,6 por ciento de las cirugías, y en el 72,0 por ciento no se presentaron complicaciones. El cáncer en estadio III y el uso de quimioterapia y radioterapia neoadyuvante mostraron riesgo con significación estadística para las complicaciones posquirúrgicas. Conclusiones: La reconstrucción mamaria mediante el uso de expansores tisulares presentó características demográficas y clínicas similares a las descritas previamente en la población cubana y el resto del mundo, aunque con peculiaridades desde el punto de vista onco-reconstructivo. La realización de la cirugía reconstructiva inmediata luego de la radioterapia neoadyuvante resultó en un mayor riesgo de complicaciones(AU)

ABSTRACT Introduction: Breast reconstruction for cancer, using the tissue expansion technique, is a technique that provides skin of natural color, texture and sensitivity. Objective: To characterize breast reconstruction with the use of tissue expanders at the National Institute of Oncology and Radiobiology of Cuba. Method: A retrospective and longitudinal study was carried out in the Reconstructive Surgery Service of the National Institute of Oncology and Radiobiology of Cuba from 2013 to 2017. The sample of 93 patients was selected consecutively from the universe of patients. Statistical analysis included Chi-square tests, estimation of the odds ratio and binary logistic regression, with a significance level of p ≤ 0,05 Results: Reconstruction predominated in women with an average age of 45.7 years, [95 percent CI (43.8-47.5) and standard deviation 9.0]. Chemotherapy was administered to 74 patients and radiotherapy to 41. Delayed reconstruction was performed in 51.6 percent of the surgeries, and in 72.0 percent there were no complications. Stage III cancer and the use of neoadjuvant chemotherapy and radiotherapy showed a statistically significant risk for postoperative complications. Conclusions: Breast reconstruction by using tissue expanders presented demographic and clinical characteristics similar to those previously described in the Cuban population and the rest of the world, although with peculiarities from the onco-reconstructive point of view. Performing immediate reconstructive surgery after neoadjuvant radiation therapy resulted in an increased risk of complications(AU)

Tissue expansion as an aesthetic alternative for facial resurfacing: a single centre series of 92 patients

Background: The visibility, vulnerability and social stigmata of facial scars whether by burn, nevi or trauma can be compelling for the patient as well as challenging for the surgeon. Restoration to normal form and aesthetics require tissue replacement which has good colour and texture match and produce minimal visible scarring.  Although many other options are available for a given defect, tissue expansion offers the best alternative which meets almost all the criteria of an ideal procedure.Methods: Among 92 patients with deformities over various facial subunits were operated and expanders 50 ml to 300 ml inserted subcutaneously adjacent to the scar. Prior planning, accurate measurement and choice of ideal expander is extremely important. A precise and practical method of calculation for determination of amount and duration of expander was used. Any secondary deformity to adjoining vital structures was avoided.Results: Results were meticulously and critically analyzed. Different shapes, dimensions and volume of expanders were used depending on the anatomical site which was to be expanded. A total of 118 expanders were inserted in 92 patients. The average volume of tissue expanders used was 170.33 ml. Majority of the expanders used had volume of 200 ml (62.71%). Post-expansion volume was 240.67 ml and the over expansion done was 41.3% over the pre-expansion volume of 170.33 ml. Surgical outcome and cosmesis was assessed by the patient’s perspective and was considered fair by 57.61% patients.Conclusions: The study underlines the clinical application, reasons for overexpansion as well as shortcomings and complications of tissue expansion.

Study of Tissue Expansion in the Reconstruction of Nevus and Scars

For management of nevus & various scars various methods are described like excision, skin grafting, dermabrasion, flap cover, dermatraction etc. but reconstruction of various scars by tissue expansion is a novel procedure. Aims & objectives: 1.Study of tissue expansion in the reconstruction of nevus & scars. 2. Advantage & disadvantages of tissue expansion. 3. Complications of tissue expansion. Methods: The study was conducted in SCB MCH, dept of Plastic surgery from October 2015 to April 2018. No. of patients in this study were 41 which includes post burn scars, post traumatic scars & nevus. Results: study includes age group from 11- 42 yrs with female predominance. It mainly includes post burn scars, facial scars. Neck was the most common site of expander used. Expander mostly used were rectangular type. Volume ranges from 50 to 540ml. Of total 46 expanders 5 cases two expanders used. Various complications of expanders included infection, blebs, hematoma, wound dehiscence etc of which extrusion of expanders were most common. Complications were more common in extremities. HTS & partial skin necrosis common scar related complication. Conclusion: Tissue expansion is an excellent technique to treat scars, pigmented lesions and alopetic patches. This provides the best tissue quality and matching as regards tissue characteristics. Flaps and skin grafts are inferior in treatment of these lesions when tissue expansion is possible. However this technique has its complications like infection, exposure and failure of expander. Therefore proper planning and selection of expander is extremely important.

Reconsidering the “MR Unsafe” breast tissue expander with magnetic infusion port: A case report and literature review

Breast tissue expanders (TEs) with magnetic infusion ports are labeled “MR Unsafe.” Therefore, patients with these implants are typically prevented from undergoing magnetic resonance imaging (MRI). We report a patient with a total submuscular breast TE who inadvertently underwent an MRI exam. She subsequently developed expander exposure, requiring explantation and autologous reconstruction. The safety profile of TEs with magnetic ports and the use of MRI in patients with these implants is surprisingly controversial. Therefore, we present our case report, a systematic literature review, and propose procedural guidelines to help ensure the safety of patients with TEs with magnetic ports that need to undergo MRI exams.

Analysis of clinical efficacy in using expanded retroauricular flap to fully cover reconstructed cartilage scaffold / 中华整形外科杂志

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.

Clinical experience and analysis on the complications of the one-stage surgery with prolonged tissue expansion in microtia reconstruction / 中华整形外科杂志

Objective@#To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications.@*Methods@#211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology.@*Results@#211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard debridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction.@*Conclusions@#Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.

Prefabricated maxillofacial and excessively expanded cervical skin flap for aesthetic unit reconstruction in the cheek / 中华医学美学美容杂志

Objective To explore a method for repairing the appearance and function of the cheek aesthetic unit.Methods A single volume of 100 ml to 150 ml of tissue expander was implanted at the lower edge of the injury area on the cheek.The first injection was performed 5 days after the operation and twice a week after the injection.It took an average of about 4 months to complete the expansion,with 3-5 times over expanded.The lesions were resurfaced with the expanded flaps,and long term follow-up was observed for flap survival.Results 17 cases of cheek lesions had been successfully reconstructed,with the color,texture of the expanded flaps well matched to the surrounding skin after 3-12 months follow-up.The facial expression functions and configurations were satisfied.Conclusions Excessive expansion of the prefabricated skin flap of the jaw and neck can repair the cheek aesthetic unit successfully,which is a practical method and meets the needs of aesthetic unit repair.

Frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi / 中华整形外科杂志

Objective@#To investigate the feasibility and therapeutic effect of frontal and scalp expanded skin flap combined with laser hair removal for children congenital facial giant nevi.@*Methods@#From January 2013 to December 2015, 6 cases with congenital facial giant nevi were treated with expanded frontal and scalp skin flap combined with laser hair removal in the department of plastic surgery, An Zhen Hospital, Capital Medical University. The process of treatment could be divided into three stages. Stage 1: The expander capacity was determined according to the size of lesion. Expander was implanted under the galea aponeurotica in front and scalp, and expanded regularly postoperatively. Stage 2: The expander was removed and facial giant nevi was excised. The expanded skin flap was designed according to the shape and size of nevi. Stage 3: After the expanded skin flap healed completely, laser hair removal was performed for 4-6 times with 6 weeks of interval time.@*Results@#300 ml to 350 ml expanders were selected with expanding frequency of 2 times a week. The expansion time lasted for 16 to 20 weeks(average, 18.7 weeks). The complications such as leakage, angle and skin flap blood supply obstacle didn't occurr in the process of expansion. The size of frontal and scalp skin flap ranged from 12 cm×11 cm to 20 cm×17 cm. Venous drainage disorder happened in one flap and was treated by partial suture removal and acupuncture bleeding treatment. Skin flap necrosis didn't occurred. The defects at donor sites were sutured directly with inconspicious scar. The effect of semiconductor laser hair removal was good without recurrence during one-year follow-up period. All expanded skin flaps had no obvious contraction with good match of color and texture.@*Conclusions@#This method provides a new selection of donor site for larger facial defect with reliable effet. The facial giant nevi could be excised completely and repaired in one operation with short operation time. The scar in middle face and secondary deformities can be avoided.

Analysis of single circumaereolar incision nipple-sparing modified radical mastectomy and immediate tissue expander implantation / 中华内分泌外科杂志

Objective To explore the safety and cosmetic effect of nipple-sparing modified radical mas tectomy and immediate tissue expander implantation with single circumaereolar incision.Methods 30 patients were enrolled in Peking Union Medical College Hospital between Jan.2014 and Dec.2015.All the patients were categorized according to surgical incision (single circumaereolar incision group vs double incisions group).Data on clinicopathological parameters,average hospital stay,complications and overall cosmetic effect were retrospectively collected.Data was performed with Chi-square test,Fisher exact test and t-test.Statistical significance was defined as P＜0.05.Results 19 patients were enrolled in single circumaereolar incision group,and 11 patients in double incisions group.There was no significant difference for operation duration (P=0.093) and average hospital stay (P=0.339).After follow-up for 19.1 months,ranging from 8 to 31 months,no patients developed seroma or arm lymphedema.There was no statistical significance between the two groups in terms of sensation in nippleaereolar area (P=0.973),bilateral symmetry (P=0.650) and overall cosmesis (P=0.483).Conclusion single circumaereolar incision nipple-sparing modified radical mastectomy and immediate tissue expander implantation can be one of the preferable surgical procedures with benefits of minimal invasiveness,reliable oncological safety and decent cosmetic effect.

Uso de expansores tisulares en defecto de cuero cabelludo / Tissue Expanders for Craniofacial Defects

Los expansores cutáneos son una alternativa reconstructiva de los defectos craneofaciales. Su objetivo es la dilatación progresiva de una zona de piel hasta conseguir un tamaño suficiente para cubrir el defecto. Se presentó la evolución y resultado estético final de un paciente masculino de 32 años de edad con defecto craneofacial por quemaduras eléctricas y el cierre del defecto mediante expansores de tejidos, atendido de conjunto Servicio de Cirugía Reconstructiva y Neurocirugía del Hospital Vladimir Ilich Lenin se obtuvo resultado estético y funcional satisfactorio.

Tissue expanders are one alternative for craniofacial defects. Its objective is the progressive dilation of a region of skin until it achieves a sufficient size to cover the defect. The evolution and aesthetic results in one patient with craniofacial defects by electrical burns was presented. The patient was treated with tissue expanders by the Aesthetic and Neurosurgery Services of Vladimir Ilich Lenin Hospital. The aesthetic and functional results were satisfactory.

A case-control study on infection following skin and soft tissue expander implantation / 中国感染控制杂志

Objective To analyze the risk factors of postoperative infection in patients with skin and soft tissue ex-pander (SSTE)implantation,and provide scientific evidence for making intervention strategies.Methods Question-naires were made,relevant data were obtained through medical record reviewing and telephone inquiry,and case-control method was used to conduct statistical analysis.Results A total of 532 patients were with SSTE implanta-tion,22 (4.14%)of whom had infection,and 14 infected patients were included in this research.Univariate logistic regression analysis indicated that there were significant difference in the number of the embedded expanders (OR=1 .58,95%CI :1 .20-2.32),the implantation site(OR =1 .75,95%CI :1 .30 -2.32),living circumstances of pa-tients(OR=1 .87,95%CI :1 .84 -2.65 ),and whether expanders were regularly disinfected(OR =2.66,95%CI :1 .76-4.32)(all P <0.05).Multivariate logistic regression analysis found that living circumstances of patients(OR=1 .55,95%CI :1 .15-2.25)and whether expanders were regularly disinfected (OR=3.66,95%CI :2.86-3.22) were two main factors entering the regression equation(both P <0.01 ).Conclusion Living circumstances of pa-tients and whether expanders are regularly disinfected are main risk factors of postoperative infection in patients with SSTE embedding.Knowledge education on preventing infection among patients and main caregivers should be strengthened,post-discharge continuous nursing system should be established.

Evaluating the Effectiveness of Cryopreserved Acellular Dermal Matrix in Immediate Expander-Based Breast Reconstruction: A Comparison Study

BACKGROUND: CGCryoDerm was first introduced in 2010 and offers a different matrix preservation processes for freezing without drying preparation. From a theoretical perspective, CGCryoDerm has a more preserved dermal structure and more abundant growth factors for angiogenesis and recellularization. In the current study, the authors performed a retrospective study to evaluate freezing- and freeze-drying-processed acellular dermal matrix (ADM) to determine whether any differences were present in an early complication profile. METHODS: Patients who underwent ADM-assisted tissue expander placement for two stage breast reconstruction between January of 2013 and March of 2014 were retrospectively reviewed and divided into two groups based on the types of ADM-assisted expander reconstruction (CGDerm vs. CGCryoDerm). Complications were divided into four main categories and recorded as follows: seroma, hematoma, infection, and mastectomy skin flap necrosis. RESULTS: In a total of 82 consecutive patients, the CGCryoDerm group had lower rates of seroma when compared to the CGDerm group without statistical significance (3.0% vs. 10.2%, P=0.221), respectively. Other complications were similar in both groups. Reconstructions with CGCryoDerm were found to have a significantly longer period of drainage when compared to reconstructions with CGDerm (11.91 days vs. 10.41 days, P=0.043). CONCLUSIONS: Preliminary findings indicate no significant differences in early complications between implant/expander-based reconstructions using CGCryoderm and those using CGDerm.

Perioperative nursing of patients with planted soft tissue expander after breast cancer surgery / 现代临床护理

Objective To explore the key points of perioperative nursing patients with planted soft tissue expander after breast cancer surgery.Method The clinical data of 55 patients with planted soft tissue expander after breast cancer surgery were reviewed to summarize the nursing measures.Result Operative process in 55 pattents were succesful,surgery time ranged from 3 to 5 hours.16 of 55 patients developed with complications and all of them were recovered and discharged.Conclusions Perioperative nursing intervention for the patients with planted soft tissue expander after breast cancer surgery can reduce the incidence of complications,improve the life quality and help them build up their confidence in social and family life.

Applicability and Safety of in Vitro Skin Expansion Using a Skin Bioreactor: A Clinical Trial

BACKGROUND: Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area. METHODS: A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos. RESULTS: The average skin expansion rate was 10.54%+/-6.25%; take rate, 88.89%+/-11.39%; and contraction rate, 4.2%+/-2.28% after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer. CONCLUSIONS: This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.

Repair of a postappendectomy massive ventral hernia using tissue expanders / 대한외과학회지

Reconstruction of large abdominal wall defects is a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report we describe our experience in treating a patient with large abdominal wall defect by staged abdominal wall reconstruction utilizing prosthetic mesh in conjunction with tissue expanders. A 41-year-old male presented with abdominal pain. Exploratory laparotomy showed perforated appendicitis with intraabdominal abscess of 1,500 mL. Postoperatively, he developed intraperitoneal sepsis. To prevent abdominal compartment syndrome, he was reoperated and left with "open abdomen". After several open abdomen lavages, his abdominal wall defect was allowed to granulate. After epithelization of the defect, the abdominal wall was reconstructed using prosthetic mesh and tissue expanders. The tissue expansion process was well tolerated. We suggest that the use of tissue expanders provides reliable and well-vascularized soft-tissue coverage in abdominal wall reconstruction.

Reconstruction of Defects after Removal of a Kissing Nevus of Eyelids using a Tissue Expander

The kissing nevus is a rare form of congenital melanocytic nevus. We present a case of a 4-year-girl with kissing nevus on the right eyelids. As a treatment, we used a tissue expander. In the first operation, The 16 cc sized rectangular-shape tissue expander was inserted within the subcutaneous layer at the right zygomatic area. After expansion for 5 months, local advancement flap was performed for lower eyelid reconstruction, and interpolation flap was carried for the upper eyelid. The remnant interpolation flap was removed and trimmed after 3 weeks. We report here a rare case of the kissing nevus on the eyelids that showed good results after reconstruction using a tissue expander.

Risk Factors of Tissue-Expander Infection in Breast Reconstruction

PURPOSE: Implant-based breast reconstruction has multiple advantages such as decreased morbidity, shorter operative time and faster recovery. However, postoperative infection with tissue expander increases medical cost and causes a delay in concurrent antineoplastic treatment. To reduce tissue expander infection, it is important to identify related risk factors and minimize them when possible. METHODS: A retrospective review of patient records in a single breast cancer center was performed. Eighty-six tissue expanders were placed in 80 women for postmastectomy breast reconstruction. Variables including patients'age, body mass index(BMI), preoperative breast volume, operation time, drain indwelling time, postoperative seroma/hematoma formation, chemotherapy, and radiation therapy were evaluated. Infection was defined as the status that shows any symptom of local inflammation and identification of pathogens. Representative values were compared through Student's t-test and univariate and multivariate analyses. RESULTS: We examined 86 postmastectomy tissue- expanders which were placed between June 2004 and April 2010. Seven cases of tissue expander infection (8.1%) were identified. The infected tissue expander was removed in three of the cases. The relationship between BMI, and preoperative breast volume and that between infection and non-infection groups were significant(p<0.05). Univariate analysis showed significant association between BMI(p=0.023) and preoperative breast volume (p=0.037). Multivariate analysis revealed that BMI and preoperative breast volume were independent variables regarding tissue expander infection. CONCLUSION: Certain characteristics of implant-based breast reconstruction patients increase infection rate of tissue expander. These risk factors should be monitored and evaluated before surgeries for more successful outcome.

Excessive expansion of cervical skin to repair lower hemifascial scar / 中华医学美学美容杂志

Objective To explore the reconstruction effects of lower hemifascial scar by cervical skin excessive volume expansion. Methods Single 100 ml or 150 ml standard volume tissue expander was implanted under the cervical skin in 50 patients with lower hemifascial scar. After the tissue expanders were injected with 4-5 times than the designed volume, the scar was resurfaced with the expanded flap. Results The excessively expanded cervical flaps of 50 patients all were successfully used to reconstruct the facial scar. The expanded flap was matched well with surrounding skin after 3-12 months following-up. No obvious contracture was observed. The district recontrueted by expended flaps have the normal expression aetivities. Conclusion Excessive expansion of cervical skin can promote the efficiency in the reconstruction of the lower hemifascial scar.

Usefulness of using Tissue Expander in Pediatric Patient

PURPOSE: Reconstruction of soft tissue defect using tissue expander can provide better flap which is more similar to surrounding tissue in color, skin texture and hair compared to other methods. Many pediatric patients need reconstruction of soft tissue defect because of giant congenital nevi, congenital or acquired malformations and burn scars. Reconstruction using tissue expander is adequate to minimize dysmorphism in these patients. We intended to assess outcomes of using tissue expander in pediatric patients by retrospective study. METHODS: Total cases were 168 of pediatric patients who received soft tissue reconstruction using tissue expander by the same surgeon from February, 1982 to May, 2009. All patients who received soft tissue reconstruction were under 10 years old. Mean age was 4.3 years old, the youngest 13 months, the oldest 8 years. Eighty-nine cases were male and 79 cases were female. Most common cause was giant hairy nevi (67 cases, 39.9%), secondary cause was burn scar/scar contracture (61 cases, 36.3%). Trunk (38 cases, 22.6%) was most common anatomical location. RESULTS: Soft tissue defects were successfully covered using tissue expander in 149 cases (88.7%) without major complications. There was infection on 8 cases (4.7%) and we treated by adequate antibiotics in these cases. There were tissue expander folding or valve displacement on 5 cases (3%). CONCLUSION: Usage of tissue expander is useful on pediatric patients because tissue expansion is rapid on children and there are less secondary contractures on operation site than full thickness skin graft. Because of psychological stress due to tissue expander, operation should be performed before school age.

The application of individual earmuffs in microtia reconstruction using tissue expander / 中国实用护理杂志

Objective To explore the protective affect of individual earmuffs in microtia reconstruction using tissue expander.Methods 95 patients performed the implantation of tissue expander had been grouped into the experimental group(49 cases)and the control group(46 cases).Patients in the experimental group wore individual earmuffs,whereas patients in the control group wore traditional earmuffs.The survey including the information of patients' experience in wearing the earmuffs was carried out on the day when patients were given auricular reconstruction.Data collected from the two groups were analyzed to evaluate the aspects of permeability and safety.Results Patients in the experimental group complained less discomfort in sultry in permeability and tinnitus than patients in the control group.From the perspective of safety,there was no complaints of mosquitoes climbing into the earmuffs from the two groups.Because of the good adhesiveness of the individual earmuffs to the skin,the incidence of redness of skin in the experimen tal group was significantly lower than that in the control group.Conclusions Individual earmuff is a safe and comfortable nursing appliance which is practical for clinical application because of its good permeability,adhesiveness and less incidence of redness of skin.