Prograde transposition for anteriorly low-set earlobe in lobule-type microtia reconstruction.

BACKGROUND: Lobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes. METHOD: A total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction. RESULTS: The patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction. CONCLUSION: The prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.

Bilateral Costal Cartilage Harvest for Auricle Reconstruction: A New Technique to Prevent Postoperative Thoracic Deformity.

HYPOTHESIS: Unilateral costal cartilage harvesting (UCCH) for auricle reconstruction in children tends to cause thoracic deformities. Therefore, our study aimed to develop a novel bilateral costal cartilage harvesting (BCCH) method to prevent and reduce thoracic deformities. METHODS: Patients with unilateral microtia who underwent either UCCH (n = 50) or BCCH (n = 46) were enrolled in this study. The grafts for the BCCH group were harvested from the 6th costal cartilage of the ipsilateral hemithorax and the 7th and 8th cartilage from the other hemithorax. Computed tomography and physical examination were performed to identify any physical deformities in the chest contours post-surgery. The cosmetic appearance of the thoracic scars post-surgery was evaluated using the Scar Cosmesis Assessment and Rating Scale (SCAR) and Visual Analogue Scales (VAS cosmetic). The numerical rating scale (NRS) was used to quantify the pain in donor sites. The reconstructed ears were assessed during the follow-up period. RESULT: None of the patients in the BCCH group developed thoracic deformities, while 16 patients within the UCCH group developed mild (n = 12) or severe (n = 4) thoracic deformities (p < 0.001). The SCAR (3.09 vs. 2.92, p = 0.580) and VAS scores (0.96 vs. 0.90, p = 0.813) did not differ significantly between the two groups. For both treatment arms, the NRS scores were highest on the first-day post-surgery and gradually dropped over the 10 days. No significant differences were found in the NRS scores and the aesthetic outcomes of the reconstructed ears between the two groups. CONCLUSION: The BCCH method effectively reduced the incidence of thoracic deformity at the donor site without increasing postoperative pain and cosmetic concerns for patients. It could be used clinically to improve patient outcomes of costal cartilage grafts. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Efectividad de la reconstrucción de la oreja con cartílago costal en el tratamiento de microtias / Effectiveness of Auricle Reconstruction with Costal Cartilage for the Treatment of Microtias

Introducción: La reconstrucción de la oreja en la actualidad es un problema difícil de solucionar. Se han propuesto varias técnicas quirúrgicas y solo las que se basan en el uso de cartílago costal autólogo son las que se aceptan a nivel mundial. Objetivo: Evaluar la efectividad de la técnica de reconstrucción del pabellón auricular descrita por Burt Brent. Métodos: Se realizó un estudio cuantitativo con diseño descriptivo de corte transversal con 41 pacientes que presentaron microtia congénita o perdida adquirida de la oreja; a quienes se les realizó reconstrucción auricular con cartílago costal autólogo tratados en el Hospital "William Soler", el Centro de Investigaciones Médico-Quirúrgica y Clínica Central "Cira García" en el Servicio de Cirugía Plástica desde 1994 hasta 2019. Se describió y se documentó la técnica empleada descrita por Burt Brent. Se utilizó una escala de 10 puntos que se basó en la anatomía auricular normal para la valoración de los resultados. Resultados: Se encontraron 32 pacientes portadores de microtia congénitas (78,04 %) y 9 pérdidas traumáticas (21,95 %), predominó el sexo femenino (56,09 %). La incidencia fue mayor en el lado derecho (68,75 %) en pacientes con microtia congénita. En el 95 % de los casos se alcanzaron resultados favorables y satisfactorios. Conclusiones: La reconstrucción del pabellón auricular requiere el empleo de un fragmento de cartílago costal de suficiente tamaño, forma y proyección. La clave consiste en esculpir un marco cartilaginoso de la oreja y mantener estos detalles a través de la piel lo más semejante a la oreja normal. Para un resultado satisfactorio se requiere una alta especialización.

Introduction: Auricle reconstruction is, nowadays, a difficult problem to solve. Several surgical techniques have been proposed and only those based on the use of autologous costal cartilage are accepted worldwide. Objective: To evaluate the effectiveness of the auricle reconstruction technique described by Burt Brent. Methods: A quantitative study with a cross-sectional descriptive design was carried out with 41 patients who presented congenital microtia or acquired loss of the ear and who were performed auricle reconstruction with autologous costal cartilage in the plastic surgery service at Hospital "William Soler", Centro de Investigaciones Médico-Quirúrgicas and Clínica Central "Cira García", from 1994 to 2019. The used technique described by Burt Brent was, in turn, described and documented. A 10-point scale based on the normal atrial anatomy was used to assess the outcomes. Results: Thirty-two patients with congenital microtia (78.04 %) and nine traumatic losses (21.95 %) were found, with a predominance of the female sex (56.09 %). The incidence was higher on the right side (68.75 %) in patients with congenital microtia. Favorable and satisfactory outcomes were achieved in 95 % of cases. Conclusions: Auricle reconstruction requires the use of a costal cartilage piece of enough size, shape and projection. The key is to sculpt a cartilaginous framework of the ear and to maintain these details through the skin as close as possible to the normal ear. A high level of specialization is required for a satisfactory outcome.

A Novel Method for Making an Auricle Framework Like Lego Building Blocks.

OBJECTIVES: The traditional Tanzer-Brent method, which uses the integral engraving of costal cartilage, provides insufficient three-dimensional sensation and is characterized by poor firmness of the auricle framework. This tends to cause the absorption deformation of the auricle framework after surgery. In order to reduce the absorption deformation as well as make the reconstructed auricle more three-dimensional and the ear shape more realistic, our ear reconstruction team invented a novel method to make an auricle framework with autologous costal cartilage. The auricle framework made by this novel method has been applied to auricle reconstruction and has achieved excellent surgical results. PATIENTS AND METHODS: Clinical data and postoperative data were collected for patients with unilateral microtia who received auricle reconstruction using the novel method of auricle framework construction in Plastic Surgery Hospital from January 2020 to June 2022. The therapeutic effect of this novel method was evaluated by the satisfaction rate of patients and their families and by the prevalence of postoperative complications. RESULTS: A total of 60 patients were enrolled in this study. The average age was (10.95 ± 2.97) years old. The mean follow-up time was 24.02 ± 1.52 months. The satisfaction rate of patients and their families was 96.7%. In terms of postoperative complications, two patients had postoperative infection, one patient had framework exposure, no patients had framework absorption and deformation, two patients had postoperative hematoma, and three patients had scar hyperplasia. CONCLUSION: This novel method of making the auricle framework is more standardized, easier to master for plastic surgeons, and more conducive to the clinical application of plastic surgery. Through this study, we believe that this novel method offers significant therapeutic advantages and can be used as a unified standard for construction of an auricle framework using autologous costal cartilage.

3D-printed high-density polyethylene scaffolds with bioactive and antibacterial layer-by-layer modification for auricle reconstruction.

High-density polyethylene (HDPE) is a promising material for the development of scaffold implants for auricle reconstruction. However, preparing a personalized HDPE auricle implant with favorable bioactive and antibacterial functions to promote skin tissue ingrowth is challenging. Herein, we present 3D-printed HDPE auricle scaffolds with satisfactory pore size and connectivity. The layer-by-layer (LBL) approach was applied to achieve the improved bioactive and antibacterial properties of these 3D printed scaffolds. The HDPE auricle scaffolds were fabricated using an extrusion 3D printing approach, and the individualized macrostructure and porous microstructure were both adjusted by the 3D printing parameters. The polydopamine (pDA) coating method was used to construct a multilayer ε-polylysine (EPL) and fibrin (FIB) modification on the surface of the 3D HDPE scaffold via the LBL self-assembly approach, which provides the bioactive and antibacterial properties. The results of the in vivo experiments using an animal model showed that LBL-coated HDPE auricular scaffolds were able to significantly enhance skin tissue ingrowth and ameliorate the inflammatory response caused by local stress. The results of this study suggest that the combination of the 3D printing technique and surface modification provides a promising strategy for developing personalized implants with biofunctional coatings, which show great potential as a scaffold implant for auricle reconstruction applications.

Comparison of auricle reconstruction with expanded flaps and auricle reconstruction with non-expanded flaps in patients with microtia: A meta-analysis.

OBJECTIVE: We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. METHODS: The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. RESULTS: The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 2.5% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 1.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 2.4% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis (P > .05). CONCLUSION: The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.

Tunneled Flaps: An Ingenious Reconstructive Option for Anterior Auricle Defects.

BACKGROUND: The anterior surface of the auricle is especially susceptible to a variety of traumatic insults and cutaneous malignancies. However, given the unique anatomy of this structure and the lack of local tissue available, the reconstruction of these defects is still a challenge. Despite of their positive outcomes, tunneled flaps have not been thoroughly explored in the literature. OBJECTIVES: To review the clinical utility of tunneled flaps in reconstructing anterior auricle defects. MATERIALS AND METHODS: A review of the literature on surgical reconstruction of the anterior auricle surface was performed in PubMed, with specific reference to tunneled flaps. CONCLUSIONS: When designed and executed properly, tunneled flaps offer unrivalled opportunities to reconstruct anterior auricle defects, with maximal preservation of the symmetry.

Socioeconomic and clinical factors influencing treatment selection in microtia and aural atresia.

OBJECTIVES: Patients with microtia and aural atresia have multiple options for treatment of conductive hearing loss (CHL) and auricle reconstruction; however, little is known about the factors influencing treatment selection. This study aims to review the socioeconomic and clinical data of microtia/atresia patients to evaluate congruency with national data and whether these factors affect treatment decisions. METHODS: Retrospective review of patients evaluated in the microtia and atresia multidisciplinary clinic (MDC) at a tertiary academic children's hospital between 2008 and 2018. Outcomes included demographic, socioeconomic and clinical factors associated with hearing surgery and framework surgery. RESULTS: 373 patients were seen in the Microtia MDC: 193 (51.7%) were male, 187 (50.1%) identified as Hispanic and 23 (6.2%) identified as Asian. 267 (75.6%) patients received a nonsurgical bone conduction hearing device (BCHD); fitting at a younger age was associated with better nonsurgical BCHD compliance. Multivariate analysis was performed on the patients that were eligible for surgery based on age and appropriate follow-up. 70 (18.8%) patients had placement of an osseointegrated BCHD; inconsistent compliance with nonsurgical BCHD decreased the odds of proceeding with osseointegrated BCHD placement. 60 (16.1%) patients underwent framework surgery for external reconstruction. Placement of osseointegrated BCHD was the only factor that was associated with proceeding with framework surgery. Other assessed demographic and socioeconomic factors were statistically not associated with selection of surgical intervention. CONCLUSION: Fitting a nonsurgical BCHD at a younger age is associated with higher likelihood of nonsurgical BCHD compliance, that is in turn associated with patients and families proceeding with osseointegrated BCHD and framework surgery.

Clinical effect evaluation and complication analysis of different auricle reconstruction of congenital microtia.

This study compared the clinical efficacy and complications of autogenous rib cartilage stent and Medpor stent auricle reconstruction in patients with congenital microtia. A total of 300 patients with congenital microtia were selected as the research objects. 150 patients in the auricle reconstruction group with autologous rib cartilage stent and 150 patients in the auricle reconstruction group with Medpor stent were selected. Postoperative follow-up was conducted to observe whether the shape, color, size, and position of the reconstructed auricle were good, and to compare whether the cranial auricle Angle was consistent with the healthy lateral auricle, so as to judge whether the reconstructed auricle was successful. The incidence of postoperative complications, such as infection and stent exposure was recorded. The postoperative satisfaction and quality of life scores were compared between the two groups. Two operation methods of the auricle reconstruction effect showed no obvious difference (P>0.05), but the incidence of auricle reconstruction scaffold exposing Medpor stenting was significantly higher than those of autologous rib cartilage auricle reconstruction. The satisfaction and quality of life scores of patients in the autologous rib cartilage group were significantly higher than those in the Medpor stent group (P<0.05). Although there was no significant difference between auricle reconstruction with autologous rib cartilage scaffold and Medpor stent implantation in the improvement rate of microtia, there were fewer complications after autologous rib cartilage stent implantation, but higher patient satisfaction and quality of life. (The registry of clinical trial is: Chinese Clinical Trial Register, ChiCTR2100052010, https://www.chictr.org.cn/).

Comparison of three-dimensional and two-dimensional templates on auricle reconstruction in patients with unilateral microtia.

To confirm the advantage of 3D template over the traditional 2D template in auricle reconstruction. Two hundred patients with Marx III unilateral microtia treated in our hospital during the last four years were included in this retrospective study. They were divided into two groups according to the surgery which was assisted by 2D or 3D template. The outcome was evaluated 6 months after the surgery in the following aspects: the mean surgical time, the similarity rate for ear size, nasal-tip to tragus length and auriculocephalic angle, the patient's satisfaction and the quality of life after surgery. The surgical time for the 3D group was 3.2 ± 1.9 hours, significantly shorter than that for the 2D group (4.1 ± 3.7 hours; P < 0.05). The similarity rates between both sides were 91.24 ± 1.71%, 96.46 ± 2.51%, and 88.15 ± 10.20% respectively for ear size, nasal tip-tragus length, and auriculocephalic angle in the 3D group. While the corresponding values in the 2D group were smaller and were 87.47 ± 3.66%, 90.16 ± 3.27%, and 78.25 ± 1.26% respectively. The difference was significant in nasal tip-tragus length and auriculocephalic angle (P < 0.05), but not for ear size (P > 0.05). The patients' satisfaction was better in the 3D group. The averaged GCBI score was 65.6 ± 13.2 in the 3D group, which was significantly higher than the value of 55.3 ± 16.8 in the 2D group (P < 0.05). The use of 3D template resulted in a better outcome in the auricle reconstruction surgery.

The testing of an artificial modified bacterial cellulose auricle skeleton in an animal model.

The aim of this study was to assess whether modified bacterial cellulose can be used for an artificial auricle skeleton. INTRODUCTION: The auricle is a part of the external ear. It consists of skin, cartilage, muscles and adipose tissue. The cartilage gives shape to the structure. There are several indications for reconstruction, such as congenital anomalies, mechanical injuries, and burns, and a range of methods have been proposed for the complete reconstruction of the auricle. MATERIAL AND METHODS: A bacterial cellulose membrane, at least 25 mm in thickness, was produced in vitro by Acetobacter xylinum culture. The entire artificial human auricle skeleton was made to scale to allow its implantation into an animal model - Wistar rats. Forty rats were divided into four groups of 10 animals. Each group was assigned a different resection time: 14 days, 30 days, 90 days or 720 days. After each resection, an examination of the artificial skeleton and the tissues surrounding it was conducted. The surgical procedure was based on the Nagata technique. RESULTS: Resection after 14, 30, 90 and 720 days shows the progression of the healing process and integration of the artificial skeleton into the animal body. There are no signs of change in the shape or structure of the skeleton. DISCUSSION: Several surgical techniques and biotechnological methods have been developed over the past few years to improve the results of facial reconstruction. Other approaches can be used to create auricle cartilage, based on scaffolds and chondrocytes. CONCLUSION: My findings indicate that modified bacterial cellulose can be used to form an effective artificial auricle which appears to maintain its shape and elasticity, with no signs of degradation.

Auricle shaping using 3D printing and autologous diced cartilage.

OBJECTIVE: To reconstruct the auricle using a porous, hollow, three-dimensional (3D)-printed mold and autologous diced cartilage mixed with platelet-rich plasma (PRP). METHODS: Materialise Magics v20.03 was used to design a 3D, porous, hollow auricle mold. Ten molds were printed by selective laser sintering with polyamide. Cartilage grafts were harvested from one ear of a New Zealand rabbit, and PRP was prepared using 10 mL of auricular blood from the same animal. Ear cartilage was diced into 0.5- to 2.0-mm pieces, weighed, mixed with PRP, and then placed inside the hollow mold. Composite grafts were then implanted into the backs of respective rabbits (n = 10) for 4 months. The shape and composition of the diced cartilage were assessed histologically, and biomechanical testing was used to determine stiffness. RESULTS: The 3D-printed auricle molds were 0.6-mm thick and showed connectivity between the internal and external surfaces, with round pores of 0.1 to 0.3 cm. After 4 months, the diced cartilage pieces had fused into an auricular shape with high fidelity to the anthropotomy. The weight of the diced cartilage was 5.157 ± 0.230 g (P > 0.05, compared with preoperative). Histological staining showed high chondrocyte viability and the production of collagen II, glycosaminoglycans, and other cartilaginous matrix components. In unrestricted compression tests, auricle stiffness was 0.158 ± 0.187 N/mm, similar to that in humans. CONCLUSION: Auricle grafts were constructed successfully through packing a 3D-printed, porous, hollow auricle mold with diced cartilage mixed with PRP. The auricle cartilage contained viable chondrocytes, appropriate extracellular matrix components, and good mechanical properties. LEVELS OF EVIDENCE: NA. Laryngoscope, 129:2467-2474, 2019.

Outcomes of the Baha Attract System combined with auricle reconstruction in mandarin speaking patients with bilateral microtia-atresia.

BACKGROUND: A transcutaneous bone-conduction hearing device (tBCHD), the Baha Attract System has been recently introduced to China, and very few studies have assessed the efficacy of this system in speakers of mandarin. OBJECTIVES: This study aims to analyze the functional and cosmetic outcomes of this system. MATERIALS AND METHODS: This prospective study included 11 patients (nine males, two females), of mean age 16 years (range 9-32 years). Seven patients were conducted the implantation simultaneously with auricle reconstruction, and the other four were before it. Auditory results were compared between unaided patients and implanted patients. Subjective satisfaction was analyzed using three questionnaires. RESULTS: The mean sound field thresholds were 65.9 ± 5.1 dB SPL unaided and 30.9 ± 4.7 dB SPL with an implanted Baha Attract System, resulting in a mean hearing gain of 35.0 ± 6.7 dB. The mean WRS scores were 47.8 ± 8.7% unaided and 92.1 ± 2.0% with the Baha Attract System, resulting in a mean improvement of 47.8 ± 8.7%. No adverse events were reported and questionnaires showed good patients satisfaction. CONCLUSIONS: The transcutaneous Baha Attract System is effective in mandarin speaking patients, and the combination of hearing rehabilitation and auricle reconstruction surgery is promising for patients with bilateral microtia-atresia.

Fabrication and characterization of 3D-printed elastic auricular scaffolds: A pilot study.

OBJECTIVE: Aesthetic reconstruction of the external ear is challenging due to the complex anatomical shape of the auricle. Recently, artificial scaffolds such as Medpor (Stryker, Kalamasoo, MI, USA) have become widely used in ear reconstruction. However, the Medpor scaffold is stiffer than the natural ear, which may lead to discomfort, and moreover has uniform design for every patient. In this study, we investigated whether three-dimensional (3D)-printed artificial polyurethane (PU) scaffolds are suitable for auricular reconstruction. METHODS: PU scaffolds were fabricated using 3D printing according to a design derived from a digital imaging and communications in medicine (DICOM) image of the human auricle. The microstructure of the scaffolds was observed using scanning electron microscopy, and the porosity was examined. Cell proliferation on the scaffolds was assessed in vitro using tonsil-derived mesenchymal stem cells to evaluate the biocompatibility of the scaffolds. The scaffolds were implanted in C57BL/6 mice, and histological analysis was performed. RESULTS: The structural study revealed that the 3D-printed porous PU scaffolds have rectangular microstructure with regular pitch and line, as well as high porosity (56.46% ± 10.22%) with a pore diameter of 200 µm. The mechanical properties of the 3D-printed PU scaffolds were similar to those of the human auricle cartilage. Cell proliferation on the PU scaffolds was greater than that on Medpor scaffolds. Histological evaluation demonstrated that the porous parts of the PU scaffolds became filled with collagen and vascular tissue. CONCLUSION: Elastic, porous PU scaffolds can be obtained using 3D printing, have biomechanical properties similar to those of the natural ear, and are suitable for use in auricular reconstruction. LEVEL OF EVIDENCE: NA Laryngoscope, 129:351-357, 2019.

Auricular reconstruction with polyethylene implants or silicone prosthesis: A single institution experience.

Auricular reconstruction is usually necessary in patients with congenital malformations, after traumatic ear amputations or in cases of neoplastic ear disease. Thirty-nine patients who underwent an auricular reconstruction with either silicon prosthesis (21 patients) or porous polyethylene (18 patients) between 2002 and 2013 were retrospectively analyzed at a tertiary academic institution. A total of 25 male und 14 female patients were included in the study. In all, 43 implants were installed in 39 patients. An implant failure was not observed in any of the examined groups. An operative revision was necessary in 5 patients in the silicon prosthesis group (N = 21) and in 4 patients in the porous polyethylene group (N = 18). The most common side effect in the porous polyethylene group was the formation of retroauricular adhesions in 11.1 % by postoperative scaring, while in the silicone prosthesis group 71.4 % of the patients presented with skin reactions around the titanium implants. Our study shows that both techniques are valuable and should be offered to patients in cases of auricular reconstruction due to the low rate of severe complications and the good functional results of both techniques.

Treatment options for partial auricle reconstruction: a prospective study of outcomes and patient satisfaction.

OBJECTIVE: To evaluate the various methods and outcomes of post-traumatic partial auricle wound reconstruction, and to review the benefit to the patient's quality of life and their psychological improvement after the operation. METHODS: The prospective study included patients who suffered from post-traumatic partial auricular wounds. The defects were repaired using various techniques including simple local cutaneous advancement flaps, tube flaps, cartilage framework using conchal and costal cartilage with local skin flap cover. RESULTS: A total of 18 patients were included, with a male predominance (sex ratio: 7:2), mean age with standard deviation of 31.66 ±9.27 years. Causes included road traffic accident (RTA), assault, human and insect bite and avulsion injuries. Injuries were sustained in the upper third of the auricle (n=8); middle third (n=5), lower third (n=3), and upper two-thirds (n=2). Out of the 18 patients, wound were repaired using post auricular mastoid skin flap (n=7); local superior and inferior chondrocutaneous flap (n=3); costal cartilage as a cartilage framework (n=4), temporoparietal fascia used to cover the costal cartilage graft (n=1), and conchal cartilage as a cartilage framework (n=3). In our study 13/18 patients were 'highly satisfied' with the aesthetic outcome, 3/18 were 'moderately satisfied', and 2/18 were 'slightly satisfied'. None were dissatisfied by the postoperative result. In terms of objective assessment, patient outcome in two patients was graded 'good' while the outcome of remaining patients (n=16) was graded as 'excellent'. CONCLUSIONS: The use of skin flaps in the post-auricular region and the mastoid region associated with or without cartilage framework yields good cosmetic and functional result. The various techniques used for ear reconstruction yielded 100% satisfactory results in terms of functional outcome as well as boosting the confidence of patients.

Aesthetic and hearing rehabilitation in patients with bilateral microtia-atresia.

OBJECTIVES: To evaluate the safety and efficacy of auricle reconstruction and active transcutaneous bone-conduction implantation in patients with bilateral microtia-atresia. DESIGN: Patients were chosen prospectively, with each being his/her own control. SETTING: The setting was a tertiary referral center. PARTICIPANTS: Twelve patients, aged 6-18 years, with bilateral microtia-atresia suffering from bilateral conductive hearing loss. All had an upper bone conduction threshold limit of 45 dB HL at frequencies of 0.5-4 kHz. MAIN OUTCOME MEASURES: Patient satisfaction with the reconstructed auricle was rated as highly satisfactory, basically satisfactory, or unsatisfactory. Mean pure-tone thresholds and speech audiometry test results were compared among patients unaided, with a soft-band Bonebridge, and with an implanted Bonebridge. Subjective satisfaction was analyzed using three questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Glasgow children's benefit inventory (GCBI), and the International Outcome Inventory for Hearing Aids (IOI-HA). RESULTS: All patients who underwent auricle reconstruction expressed satisfaction with their appearance. The mean pure-tone thresholds of unaided patients and those with soft-band and implanted Bonebridge were 55.25 ± 3.43 dBHL, 31.37 ± 3.03 dBHL, and 21.25 ± 2.16 dBHL, respectively. The mean speech discrimination scores measured in a sound field with a presentation level of 65 dB SPL under these three conditions were 46.0 ± 0.11%, 80.0 ± 0.09%, and 94.0 ± 0.02%, respectively. Questionnaires demonstrated patients' benefits and satisfaction with this surgery. CONCLUSIONS: The surgical procedure involving auricle reconstruction and Bonebridge implantation was safe and effective for patients with bilateral microtia-atresia, solving both appearance and hearing problems.

A Simplified Reconstructive Technique for Full-thickness Central Defects of the Auricle with the Use of a Post-auricular Folded Flap.

BACKGROUND: Post-auricular flaps have proved very effective in the reconstruction of most types of partial auricular defects. However, few reports exist regarding the reconstruction of centrally located perforating defects of the auricle. OBJECTIVES: This paper aimed to describe a one-stage technique including a post-auricular folded flap (PAFF) for reconstruction of full-thickness defects of central auricular sites. PATIENTS AND METHODS: Between March 2010 and November 2014, five male patients were treated with this reconstructive technique under local anaesthesia. At the time of surgery, patients' age ranged from 76 to 86 years (mean age, 79.8). The patients suffered from a central and full-thickness defect owing to surgical excision of a skin malignancy or failed reconstruction procedures secondary to surgical excision of a skin malignancy. RESULTS: Healing was uneventful for all the included patients, without signs of dehiscence, necrosis, hematoma and infection. The defects were completely repaired, without the need of further operations. During the follow-up period, all the patients remained satisfied with the aesthetic outcome. CONCLUSIONS: This technique constitutes an immediate, effective and low-morbidity procedure to repair full-thickness central defects of the auricle. Since PAFF requires only one surgical operation under local anaesthesia, patients with burdened medical history may profit from this technique.

Patient Satisfaction and Its Influencing Factors of Microtia Reconstruction Using Autologous Cartilage.

BACKGROUND: This study aimed to investigate patient perceptions of and satisfaction with surgical outcomes of microtia reconstruction using autologous cartilage. It also analyzes associations between patient background characteristics and their evaluation. METHODS: Lobule-type microtia patients who had received first-stage surgery were interviewed using a questionnaire, which included assessment of nine auricle substructures, superior and inferior parts and overall impression. Answers were recorded on a five-point Likert-style scale. Satisfaction rate and average scores were used to compare satisfaction with different substructures. Chi-square tests and logistic regression were used to analyze the impact of background characteristics such as gender, age, side and body mass index (BMI) on satisfaction, measured as the total scores for different parts. RESULTS: The highest level of satisfaction was seen for the helix and the lowest for the tragus. The average score for the helix was significantly higher than for the concha (p < 0.05), tragus (p < 0.05), anti-tragus (p < 0.05), incisura (p < 0.05) and lobe (p < 0.05). The overall satisfaction was significantly correlated with work on the inferior part (ρ = 0.63, p < 0.05). Satisfaction from children under 12 years old was significantly higher than from children above 12 years old for superior structures and overall evaluation (p < 0.05). Left-sided microtia patients showed significantly higher satisfaction for inferior structures and overall evaluation than right-sided patients (p < 0.05). Overweight and obese patients were less satisfied with the tragus-incisura-anti-tragus complex compared with the rest (p < 0.05). CONCLUSION: Microtia patients were most satisfied with the helix and least satisfied with the tragus. Overall patient satisfaction was more dependent on inferior structures; the characteristics of younger age (<12 years), proper BMI (under overweight or obese) and left-sided microtia were linked with higher ratings. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Application progress of digital technology in auricle reconstruction].

Objective: To review the application progress of digital technology in auricle reconstruction. Methods: The recently published literature concerning the application of digital technology in auricle reconstruction was extensively consulted, the main technology and its specific application areas were reviewed. Results: Application of digital technology represented by three-dimensional (3D) data acquisition, 3D reconstruction, and 3D printing is an important developing trend of auricle reconstruction. It can precisely guide auricle reconstruction through fabricating digital ear model, auricular guide plate, and costal cartilage imaging. Conclusion: Digital technology can improve effectiveness and decrease surgical trauma in auricle reconstruction. 3D bioprinting of ear cartilage future has bright prospect and needs to be further researched.