Summary and analysis of total auricle reconstruction in adult microtia patients / 中华耳鼻咽喉头颈外科杂志

Objective: To observe the clinical effect of auricle reconstruction in adult patients with microtia and summarize the experience. Methods: Clinical data of adult patients with microtia who underwent total auricle reconstruction using the modified Nagata's two stage for microtia reconstruction from June 2016 to June 2021 were analyzed. A total of 41 adult patients (42 ears) with microtia were enrolled, including 30 males and 11 females, with the median age at the time of surgery of 37 years. Autogenous costal cartilage was used as the auricular framework for all patients in this group. The first stage surgery was performed according to the modified Nagata's two stage for microtia reconstruction procedure,cartilage auricular framework carving was performed by different methods according to the ossification state of adult costal cartilage. Six months following the primary operation, ear elevation and cranioauricular angle formation, retroauricular facial flap transfer and medium-thick skin grafting were performed in the second stage. Results: All patients successfully completed two stage operation. During the follow-up of 3 months and 24 months, all the 41 patients were satisfied with the morphology of reconstructed auricle. Conclusion: According to the costal cartilage status of adult patients, different costal cartilage carving techniques can be used for total auricle reconstruction to obtain ideal surgical results.

Auricular reconstruction for microtia with modified Nagata method / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate a method for total reconstruction of auricle.</p><p><b>METHODS</b>90 patients (101 ears) with congenital microtia underwent two-stage operations for auricular reconstruction. The first stage involved fabrication and grafting of autologous costal cartilage, removing the remnant ear cartilage, embedding the framework into local flap of the mastoid region, transferring the remnant ear lobule flap to link to the inferior framework. The second stage was creating an auriculocephalic sulcus. The reconstruction was performed 4 - 12 months after the first surgery. Skin incision was made 5 mm lateral side of the posterior margin of the auricle. The ear framework carrying a thick ear fascia was separated from the side of the head, the frames of the costal cartilage banked at the first operation were harvested, shaved and transplanted to the posterior wall of the concha with sutures; adjust stand position and angle, so that made the ear shape, position, axis, close to the healthy ear, and auriculocephalic angle was slightly larger than the contralateral ear. Two random flap was designed with superior on the root of the helix and in the inferior-posterior direction of the inferior mastoid area, two flapes were elevated and transplanted to posterior auricular sulcus to cover the grafted cartilage. Skin graft was performed in the remaining raw surface.</p><p><b>RESULTS</b>A total of 90 patients were operated, all of 101 constructed ears achieved satisfied or near satisfied shapes. Five cases of partial skin flap necrosis were caused by pedicle impairment. Exposure of cartilage framework happened in two cases. The auriculocephalic sulcus of four cases diminished after the second stage operation. Three month to two-year follow-up of 67 patients showed that the reconstructed ears were satisfied with the results, including good shapes and steady auriculocephalic angles.</p><p><b>CONCLUSIONS</b>The method is a simple, safe and reliable method for total aural reconstruction.</p>

Creation of auriculocephalic sulcus with two random skin flaps from mastoid area combined with skin graft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the method for creation of auriculocephalic sulcus.</p><p><b>METHODS</b>The reconstruction was performed 4-12 months after the first surgery. Skin incision was made 5mm posterior to the outer margin of the auricle. The ear framework was elevated with a thick fascia at the deep surface. The costal cartilage banked at the first operation was shaved and transplanted to the deep surface of the concha with sutures. The position and angle of the ear framework was adjusted to be familiar to the healthy ear. The auriculocephalic angle was slightly larger than that in the contralateral ear. Two flaps were designed at the upper and lower area of reconstructed ear and rotated to cover the cartilage. The wound at the donor site was closed with skin graft.</p><p><b>RESULTS</b>A total of 72 patients were treated. All the flaps survived completely. 51 patients were followed up for 3-24 months with satisfactory results. The auriculocephalic sulcus maintained at about 20-30 degree.</p><p><b>CONCLUSIONS</b>It is a simple, safe and reliable method to create a auriculocephalic sulcus with two random skin flaps from mastoid area combined with skin graft.</p>

Reconstruction of segmental ear helix defect with post-auricular skin flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the method of repairing segmental ear helix defect.</p><p><b>METHODS</b>Twenty-one patients with segmental ear helix defect were repaired with post-auricular skin flap. In the first stage operation, ear helix defect was assessed, including the anterior and posterior area defect. According to the defect, post-auricular skin flap was designed and transplanted to repair the defect. Six weeks later, the pedicle of the post-auricular skin flap was cut off, elevated, and folded to form the helix. The secondary defect was directly sutured or repaired with skin graft.</p><p><b>RESULTS</b>Twenty-one patients were treated with this method. In two to 12 months follow-up, all flaps survived and reconstructed ear helices were in good shape. The reconstructed ears were in symmetry to the healthy ones.</p><p><b>CONCLUSION</b>The method is safe and effective for the correction of segmental ear helix defect.</p>

Modified two-stage surgery for total auriculoplasty with autogenous rib cartilage / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce a modified surgery for total auriculoplasty and the experience in one hundred and forty-six cases (155 ears).</p><p><b>METHODS</b>The procedure was a two-stage operation. The first stage involved fabrication and grafting of a costal cartilage framework. A U-shaped skin incision was made on the posterior edge of the lobule and the remnant ear cartilage was removed completely. The area for the insertion of the cartilage framework was undermined. Skin flaps were sutured after insertion of the cartilage framework. The second-stage surgery was usually performed six months after the first-stage operation. The reconstructed auricle was elevated, and a costal cartilage block was fixed to the posterior part of the auricle. A temporoparietal fascia flap was then used to cover the costal cartilage block. Finally, the posterior aspect of the projected auricle was covered with a spit-thickness skin graft.</p><p><b>RESULTS</b>The incisions healed in one hundred and forty-one patients (150 ears) after the first stage operation. Partial necrosis of the postauricular flap was observed in five cases (5 ears) after the first stage operation, but no exposure or absorption of the cartilage took place. The skin grafts survived in one hundred and thirty-nine cases (147 ears) after the second-stage surgery. Partial necrosis of the skin graft was observed in seven cases (8 ears), but healed after one-week of dressing changes. Ninety-four cases (97 ears) were followed up, but fifty-two cases (58 ears) were lost to follow up. The follow-up at six months to two years showed satisfactory contour and projection of the constructed ears.</p><p><b>CONCLUSION</b>This two-stage surgery is simple and ideal for auricloplasty with few complications.</p>

Combined superficial temporal fascial flap with free dermis-fat graft to reconstruct hemifacial atrophy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce a method to reconstruct hemifacial atrophy (Romberg's disease).</p><p><b>METHODS</b>Through a temporal incision, the compound grafts of pedicled superficial temporal fascial flap and free dermis-fat were inserted into the cheek to correct soft tissue depression on the face. The dermis-fat was harvested from gluteal crease site.</p><p><b>RESULTS</b>6 cases were treated with this technique. 3 to 10 months' follow-up showed satisfactory results and few resorption of the compound grafts.</p><p><b>CONCLUSIONS</b>The mentioned technique is simple and reliable in reconstructing bulk defects of the face.</p>

Repairing the defects in the chest, back and axilla with a split-breast flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate a method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla.</p><p><b>METHODS</b>Eight patients, with the defects after the secondary tumor excision and the radiation ulcer in the chest, back and axilla, were undergoing the treatment. A "T" shape incision or up-side-down "T" shape incision was designed above the breast or along the inframammary fold below breast, just close to the defect. A split-breast flap was raised above the pectoralis major or deep fascia. The defect was then repaired with a rotating and advancing way.</p><p><b>RESULTS</b>Eight patients were repaired in one stage. Blood circulation of the flaps was abundant except one with distal edge necrosis. The ptosis breast was corrected and the fullness of the chest wall was also achieved. But, the Nipple of the opposite health breast was lost the original position to the lateral or medial.</p><p><b>CONCLUSIONS</b>The above-mentioned technique may be an efficient method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla. It is adapt to the old patients whose health is worse, but it is not good for the young patients resulted from the injury breast.</p>

Complication of polyacrylamide hydrogel injection for facial plasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the causes of complications of polyacrylamide hydrogel injection for facial plasty and reliable treatments.</p><p><b>METHODS</b>Eight patients were included in the study. Some of them were examined by MRI. All the patients received surgical treatments.</p><p><b>RESULTS</b>The injected polyacrylamide hydrogel was found in the superficial layer of the superficial temporal fasica, the loose connective tissue below the deep temporal fascia, the subcutaneous tissue or the orbicularis muscle. Polyacrylamide hydrogel injected into the superficial layer of the superficial temporal fascia could spread to the face along the SMAS. Polyacrylamide hydrogel injected into the loose connective tissue below the deep temporal fascia could spread down to the cheek. The patients' symptoms were relieved with the operation. Satisfactory results were obtained.</p><p><b>CONCLUSION</b>Polyacrylamide hydrogel injection does not adapt to facial plasty. The reliability of polyacrylamide hydrogel injection for facial plasty is in doubt.</p>