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Objective@#To summarize the clinical effect of using the composite flap of microtic cartilage and soft tissue in tragus reconstruction to correct preauricular depression.@*Methods@#From January 2015 to November 2016, we corrected preauricular depression of 523 patients with congenital microtia that were treated with tragus reconstruction by using the composite flap of residual ear cartilage and soft tissue.@*Results@#All the composite flap of residual ear cartilage and soft tissue were transplanted successfully. No blood circulation disorder and significant contracture occurred. All patients were followed up for 6-14 months with an average of 10 months. The reconstructed tragus looked projective and the preauricular depression was corrected, demonstrating a similar looking to the healthy side. The patients were satisfied with the results.@*Conclusions@#The residual ear tissue could form the composite flap of residual ear cartilage and tissue. Using the composite flap to fill the preauricular depression was effective, which was not easily absorbed. The residual ear tissue is the best resource for filling the preauricular depression. It should not be discarded in ear reconstructive surgery, but reserved for the next operation for tragus reconstruction.
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Objective To explore the effect of subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction on moderate and severe inverted nipple.Methods 33 patients with 59 moderate and severe inverted nipples were involved in this study.The bilateral subcutaneous triangular composite tissue flaps pedicled with the base of the nipple were harvested within areola,the two triangular composite tissue flaps were revolved and advanced either horizontally to the opposite pedicle through the tunnel beneath the nipple and fixed as supporting.After the operation,the continuous distraction of the nipple lasted for two to four weeks,clinical effect and complications were analyzed.Results None of these 59 nipples appeared blood circulation disorder after operation.Postoperative follow-up for 6 months to 3 years showed that 54 inverted nipples were corrected completely without complications,such as nipple and areola necrosis,and there were no recurrence.The patients and doctors were satisfied with the appearance of the nipples.Conclusions Correcting the moderate and severe inverted nipple with subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction is simple,microinvasive,effective,and the incision scar is invisible,and it therefore is an ideal method for correcting the inverted nipple.
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PURPOSE: Even in a small levator resection for blepharoptosis, 10-13mm of Muller's muscle and levator aponeurosis is resected. To solve the problem, Muller's muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study is to evaluate the effectiveness of the Muller's muscle-levator aponeurosis complex advancement technique for the correction of blepharoptosis. METHODS: From 2003 to 2008, 107 patients(183 eyes) underwent the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2-3mm of distal flap stump was left after trimming up to 5mm. The results of the operations were evaluated. RESULTS: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes(88.3%) showed a normal level of upper eyelid margin(MRD1 4.1-5.0mm) or less than 1mm ptosis(MRD1 3.1-4.0mm). 10 eyes(6.9%) showed 1-2mm ptosis(MRD1 2.1-3.0mm). 7 eyes(4.8%) showed more than 2mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5-6mm of composite flap advancement and 20% had about 3mm of the flap stump trimmed with 8-9mm of composite flap advancement (shortening of the levator complex). CONCLUSION: Muller's muscle-levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning Muller's muscle; it is more physiological; it is reproducible and it is predictable-with gratifying results for blepharoptosis.
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Animales , Humanos , Tobillo , Blefaroptosis , Conjuntiva , Ojo , Párpados , MúsculosRESUMEN
Objective To study the method and efficacy of repairing cup ear deformity.Methods The mild cup ears were corrected by V-Y advanced flaps and retroauricular flaps(seventeen ears),and the severe cup ears corrected by rotate composite flaps of concha auriculae and retroauricular flaps(six ears).The donor defects were sutured in place in seven cases and repaired by skin grafting in six cases.From March 2000 to November 2005,sixteen cases(twenty-three ears),eleven patients were male and five female,with age range from eight to thirty-six years,were treated by the procedures mentioned above.Among them,twelve cases were mild cupping(five bilateral ears) and four cases severe cupping(two bilateral ears).Results All flaps survived with primary healing after operation.Follow-up from six months to two years showed that all the patients had achieved satisfactory appearance of external ear and obvious improvement of contour of auricle and cavity of concha.Conclusion V-Y advanced flap and rotate composite flap are effective methods for the correction of cup ear deformity.The rational using of retroauricular flap and fixation of contour of auricle and cavity of concha are also the key points for the operation.
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Successful regeneration of a cartilage framework using perichondrium has been reported by several authors but there are some arguments surrounding mucosal regeneration. Some authors report that regeneration of mucosa is completed by ingrowth from neighboring tissue but others insist that it occurs via metaplasia from the squamous epithelium. This study was designed to investigate the differences in regeneration between nonvascularized and vascularized flaps. A 5 X 15mm sized vascularized composite flap composed of vascularized perichondrium pedicled on the central auricular artery and free buccal mucosa which was harvested from the oral cavity and sutured on the vascularized perichondrium was fabricated in a rabbit ear. It was transferred to a pre-created 4 X 12mm tracheal defect. A morphologic study was carried out to determine the outcome of the grafted mucosa at regular intervals under light microscopy after H and E staining. A nonvascularized perichondrial-mucosal composite flap with the same dimension was transferred in the control group. The results are as follows;1) The control group showed necrosis of the grafted mucosa and defective area was covered by ingrowth of the neighboring normal mucosa. The periphery of the defective area regenerated earlier than the central area and immature epithelia were still found 6 weeks after the graft. Regeneration of cilia was rather inconsistently observed 8 weeks after the transfer. 2) In the experimental group, the grafted mucosa survived on the vascularized perichondrium which was thought to act as a vascularizing bed. Two weeks after reconstruction, the covering epithelium appeared almost as normal as the tracheal columnar epithelium. At 4 weeks, the regenerated mucosa could hardly be distinguished from the normal mucosa. Regeneration of cilia was consistent at 6 weeks in the experimental group. Mucosal regeneration in the experimental group was superior to the control group in terms of degree and quality. Mucosal coverage of the control group occurred by ingrowth from the neighboring mucosa. In the experimental group, survival of the grafted mucosa relied upon revascularization through the vascular pedicle. It can be conceived that metaplasia of the grafted mucosa occurs in a vascularized composite flap transferred group. In conclusion, maintenance of vascularization is essential to successful regeneration of grafted mucosa with good quality.