Incision and drainage with daily irrigation for the treatment of auricular pseudocyst

Introduction: Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this condition is to keep acceptable cosmetic results with no recurrence rate. Objective: To demonstrate the superior impact of incision and drainage of auricular pseudocysts with the insertion of a catheter drain and daily irrigation as the treatment of this condition. Methods: A total of 42 patients with auricular pseudocysts were enrolled in the present study in the period between May 2011 and May 2017. All of the patients were treated with incision and drainage with compression. The average follow-up time reached ~ 6 months in all of the cases. Results: All of the patients had satisfactory cosmetic results with no recurrence and no complications. Conclusion: Among the different methods of surgical treatment of pseudocyst of the pinna, incision and drainage with daily irrigation is a significantly efficientmethod both for the eradication of auricular pseudocysts and for good cosmetic results (AU)

The Conchal Vascular Foramen of the Posterior Auricular Artery: Application to Conchal Cartilage Grafting.

The posterior auricular artery (PAA), a branch of the external carotid artery, gives rise to a conchal network formed by PAA perforators through the conchal floor of the auricle. However, this branch and its entrance (foramen) to the anterior concha, is rarely illustrated in the literature and has not been studied in detail. Therefore, we aimed to investigate the morphology of the perforating artery (PA) and its vascular foramen (VF). Ten sides from five formalin-fixed frozen Caucasian cadaveric heads were used. The number, diameter of the VF, diameter of the perforating artery (PA), shape of the VF (circular or oval), distance from the middle of the tragus and origin of the artery were documented. The number of VF ranged from 1 to 2; one was seen on 90% of the sides and two were seen on 10% of the sides. The VF was oval in 36% of the sides and circular in the remaining 64%. The mean diameter of the long and short axes of the VF, and PA was 2.0±1.4 mm, 1.3±0.9 mm, and 0.7±0.4 mm, respectively. Diameter of the PA was 1.0 mm or greater in 18% of the sides. The mean distance from the middle of the tragus to the VF was 10.7±2.6 mm. The perforating artery of the concha originated from the posterior auricular artery on all 11 sides.

Videomicroscopy as a tool for investigation of the microcirculation in the newborn.

The perinatal period remains a time of significant risk of death or disability. Increasing evidence suggests that this depends on microcirculatory behavior. Sidestream dark-field orthogonal polarized light videomicroscopy (OPS) has emerged as a useful assessment of adult microcirculation but the values derived are not delineated for the newborn. We aimed to define these parameters in well term newborn infants. Demographic details were collected prospectively on 42 healthy term neonates (n = 20 females, n = 22 males). OPS videomicroscopy (Microscan) was used to view ear conch skin microcirculation at 6, 24, and 72 h of age. Stored video was analyzed by a masked observer using proprietary software. There were no significant differences between the sexes for any structural parameters at any time point. There was a significant increase over time in small vessel perfusion in female infants only (P = 0.009). A number of 6- and 72-h measurements were significantly correlated, but differed from the 24-h values. These observations confirm the utility of the ear conch for neonatal microvascular videomicroscopy. They provide a baseline for studies into the use of OPS videomicroscopy in infants. The changes observed are comparable with previous studies of term infants using these and other microvascular techniques. It is recommended that studies for examining the mature neonatal microvascular structure be delayed until 72 h of life, but studies of the physiology of cardiovascular transition should include the 24-h time point after delivery.

Condrodermatitis nodular del antihélix por teléfono móvil / Cell Phone–Induced Chondrodermatitis Nodularis Antihelicis

No disponible

Prefabrication of 3D cartilage contructs: towards a tissue engineered auricle--a model tested in rabbits.

The reconstruction of an auricle for congenital deformity or following trauma remains one of the greatest challenges in reconstructive surgery. Tissue-engineered (TE) three-dimensional (3D) cartilage constructs have proven to be a promising option, but problems remain with regard to cell vitality in large cell constructs. The supply of nutrients and oxygen is limited because cultured cartilage is not vascular integrated due to missing perichondrium. The consequence is necrosis and thus a loss of form stability. The micro-surgical implantation of an arteriovenous loop represents a reliable technology for neovascularization, and thus vascular integration, of three-dimensional (3D) cultivated cell constructs. Auricular cartilage biopsies were obtained from 15 rabbits and seeded in 3D scaffolds made from polycaprolactone-based polyurethane in the shape and size of a human auricle. These cartilage cell constructs were implanted subcutaneously into a skin flap (15 × 8 cm) and neovascularized by means of vascular loops implanted micro-surgically. They were then totally enhanced as 3D tissue and freely re-implanted in-situ through microsurgery. Neovascularization in the prefabricated flap and cultured cartilage construct was analyzed by microangiography. After explantation, the specimens were examined by histological and immunohistochemical methods. Cultivated 3D cartilage cell constructs with implanted vascular pedicle promoted the formation of engineered cartilaginous tissue within the scaffold in vivo. The auricles contained cartilage-specific extracellular matrix (ECM) components, such as GAGs and collagen even in the center oft the constructs. In contrast, in cultivated 3D cartilage cell constructs without vascular pedicle, ECM distribution was only detectable on the surface compared to constructs with vascular pedicle. We demonstrated, that the 3D flaps could be freely transplanted. On a microangiographic level it was evident that all the skin flaps and the implanted cultivated constructs were well neovascularized. The presented method is suggested as a promising alternative towards clinical application of engineered cartilaginous tissue for plastic and reconstructive surgery.

The effect of "minimally invasive transfer of angiosomes" on vascularization of prefabricated/prelaminated tissues.

Prefabrication and prelamination are experimental and clinical applications of reconstructive surgery and inspired the vascularization challenge of engineered tissues. The purpose of this study is to test the efficiency of "minimally invasive transfer of angiosomes" to enhance the vascularization of the final construct during prefabrication and prelamination. Fifteen rabbits were used for this study. Three of the animals were used in a pilot study to develop the protocol. During the study, thoracodorsal and lateral thoracic vascular pedicles on each side constituted 4 study groups. The pedicles were prepared to simulate prelamination with and without transfer of angiosomes, and prefabrication with and without transfer of angiosomes. In all of the groups, a 10 x 15 mm auricular cartilage graft was used as the construct to be vascularized. After 2 weeks, vascularization of the grafts was evaluated by means of microangiography and histology. Results indicate that both prelamination and prefabrication with transfer of angiosomes displayed better vascularization, both qualitatively and quantitatively. However, prelamination with transfer of angiosomes group displayed distinct statistical superiority. The results suggest that minimally invasive transfer of angiosomes coupled with the procedure significantly increases the induction of angiogenesis during prelamination and prefabrication.

Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory.

OBJECTIVES: Chondrodermatitis nodularis chronica helicis (CNCH) usually presents as a painful nodule affecting the pinna. The aetiology of the disease is unknown. Several theories have been suggested. We suggest a possible explanation based upon pathophysiological treatment correlations to new histopathological evidence. DESIGN: A detailed histopathological review of 16 confirmed cases of CNCH was undertaken by two pathologists, independently and together, using a qualitative grading of arteriolar narrowing. RESULTS: Review of cases revealed arteriolar narrowing in perichondrium region of pinna most remote from arterial blood supply, i.e. helix. This has lead to ischaemic changes and death of the metabolically active underlying cartilage with necrosis and extrusion. CONCLUSION: This is the first report of specific perichondrial arteriolar changes as the possible cause of underlying cartilage necrosis resulting in CNCH.

Totally avulsed ear: new technique of immediate ear reconstruction.

INTRODUCTION: Reconstruction of the avulsed auricle remains a challenge to the plastic surgeon. Many surgeons suggest reattachment of the total or subtotal amputated ear as a composite graft, but this solution is unreliable. Some surgeons advocate the use of the retro auricular pocket to enhance survival of the reattached ear. However, this burying method entails multistage procedures with somewhat poor results due to the associated fibrosis. Microsurgical replantation can be performed but its applicability is limited due to difficulty with venous drainage. In this paper we advocate the use of a technique of total ear reconstruction using the cartilage of the avulsed ear in a single stage. PATIENTS: Three patients with a mean age of 36 years, all of whom were heavy smokers, were operated upon between February 2006 and January 2007. Surgery involved removal of the skin of the amputated ear and immediate reattachment. The ear cartilage was then, immediately covered with an ipsilateral temporoparietal fascia flap and a split thickness skin graft. RESULTS: Acceptable aesthetic results were obtained in all three cases. A minor complication of limited skin graft loss occurred in one case. CONCLUSION: Our technique is simple, one stage and maintains the delicate detail of the auricular cartilage.

Total lower eyelid reconstruction with a prefabricated flap using auricular cartilage.

INTRODUCTION: Various methods have been reported for reconstructing the lower eyelid, but there is still the problem of creating a deep fornix and a supportive eyelid for housing an artificial eye. CASE REPORT: A new prefabricated flap was developed using auricular cartilage and the lateral femoral circumflex vessels as vascular pedicles. This was applied in a 64-year-old male patient with total lower eyelid loss following an extended maxillectomy for tumour. CONCLUSION: The prefabricated flap described here showed more flexibility and a longer vascular pedicle, thus improving the applications for use in patients with limited recipient vessels yet without major sacrifice or deformity in the donor area.

Stimulation of in vivo angiogenesis by cytokine-loaded hyaluronic acid hydrogel implants.

Crosslinked hyaluronic acid (HA) hydrogels were evaluated for their ability to elicit new microvessel growth in vivo when preloaded with one of two cytokines, vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF). HA film samples were surgically implanted in the ear pinnas of mice, and the ears retrieved 7 or 14 days post implantation. Histologic analysis showed that all groups receiving an implant demonstrated significantly more microvessel density than control ears undergoing surgery but receiving no implant (p < 0.01). Moreover, aqueous administration of either growth factor produced substantially more vessel growth than an HA implant with no cytokine. However, the most striking result obtained was a dramatic synergistic interaction between HA and VEGF. Presentation of VEGF in crosslinked HA generated vessel density of NI = 6.7 at day 14, where NI is a neovascularization index defined below, more than twice the effect of the sum of HA alone (NI = 1.8) plus VEGF alone (NI=1.3). This was twice the vessel density generated by co-addition of HA and bFGF (NI=3.4, p<0.001). New therapeutic approaches for numerous pathologies could be notably enhanced by the localized, synergistic angiogenic response produced by release of VEGF from crosslinked HA films.

[The structure of the skin of the ear in domesticated pigs, with special reference to their use for human dermatological research. 2. Specific histology of the integument]. / Untersuchungen zur Struktur der Ohrhaut beim Hausschwein, unter besonderer Berücksichtigung einer Verwendung in der humandermatologischen Forschung: 2. Spezielle Histologie des Integuments.

Based on light microscopy, the study describes the specific histology of the ear integument of the white domesticated pig. After careful tissue fixation and embedding, routine histological staining, collagen fibre staining, fat demonstration based on frozen sections, and ink injection of the integumental blood vessel system were applied. A detailed description is presented of the structure of the skin layers (epidermis, dermis, hypodermis), the ear cartilage envelopes (fascia, perichondrium), the plica scaphae, the blood vessel distribution, the architecture of the collagen fibre bundles, as well as the hair follicles and the skin glands (sebaceous glands, apocrine tubular glands). The results are discussed with regard to a direct comparison with the histological structure of the human integument, and the advantages and disadvantages of the use of the porcine ear skin as model system in human dermatological research are emphasized.

Prefabrication of combined composite (chimeric) flaps in rats.

The purpose of this study was to prefabricate a new combined composite (chimeric) flap that consists of four different tissues. The tissues were prefabricated around two independent pedicles that ultimately join as a single main pedicle. In the inguinal area of 36 rats, the saphenous and the superficial inferior epigastric (SIE) pedicles were dissected and prepared as vascular carriers. A fascial graft and a local muscle flap were wrapped around the saphenous pedicle. The SIE pedicle was then implanted under the abdominal skin to supply a future skin flap. An ear cartilage graft was also inserted under the abdominal skin and adjacent to the implanted SIE pedicle. After allowing 2-, 4-, 6-, and 12-week prefabrication periods in different groups of nine animals, the prefabricated tissues were raised around two pedicles nourished by the femoral pedicle and then transferred. Flap survival was assessed by observation, microangiography and histology. The skin flaps showed survival rates of 52 +/- 17% (mean +/- standard error of the mean), 64 +/- 16%, 86 +/- 11%, and 100 +/- 0% of the total areas in the 2-, 4-, 6-, and 12-week prefabricated flaps respectively. None of the control grafts that were prepared on the contralateral side survived totally. A significant difference was found between the 12- and 2-week (p < 0.008), 12- and 4-week (p < 0.02), and 6- and 2-week (p < 0.05) prefabrication groups. Histologically, fascial and cartilage grafts, and portions of muscle were viable in the 2- and 4-week groups. Also, noticeable necrosis was found in the skin flaps in these groups. The muscle showed mild (at 2, 4, and 6 weeks) and moderate (at 12 weeks) atrophy. After prefabrication for 6 weeks, all tissues demonstrated good survival. This study shows that a combined composite flap can be prefabricated successfully in rats after a 6-week period of prefabrication.

[Technique for registration of auricular pulsogram in macaca mulatta monkeys]. / Metodika registratsii ushnoi pul'sogrammy u obez'ian makakov rezusov.

An upgraded technique for registration of auricular pulsogram in monkeys (Macaca mulatta) has been proposed to study shifts in the common artery bed. The measurement is made with a photo-electrical sensor taped to the cartilage of the floor of the auricle and secured with a special cap and helmet of elastic net, and a system for data transfer from the sensor to a register enhanced by preamplifiers. Potentialities of the technique are exemplified by the investigation of Macaca mulatta's tolerance of +Gz loads.

Long-term growth of a vascularized auricular perichondrocutaneous flap in laryngotracheal reconstruction.

This study addresses the potential for ongoing cartilage proliferation after repair of laryngotracheal stenosis with vascularized perichondrium. We randomly assigned 32 New Zealand white rabbits to 1 of 3 groups: group 1 (early cartilage growth, n = 10), group 2 (long-term cartilage growth after pedicle ligation, n = 11), and group 3 (long-term cartilage growth without pedicle ligation, n = 11). Bilateral auricular perichondrocutaneous flaps were elevated and transposed into full-thickness anterior tracheal wall or anterior cricothyroid membrane defects. Six weeks after elevation of the flap, animals were randomly assigned to undergo ligation of either the right or left vascular pedicle (group 2), with the contralateral auricular flap used as a matched control (group 3). Neochondrogenesis was present at 6 weeks in group 1 (0.74 +/- 0.14 mm, n = 12 ears). Cartilage thickness did not differ between groups 2 and 3 one year after ligation of the vascular pedicle: group 2 (0.48 +/- 0.24 mm, n = 18) versus group 3 (0.42 +/- 0.12 mm); P > 0.05. We conclude that in the rabbit model, chondrogenesis did not appear to be ongoing and did not result in late stenosis of the reconstructed airway. Furthermore, delayed ligation of the vascular pedicle neither inhibited nor stimulated cartilage proliferation.

Blood flow rate in arteriovenous anastomoses and capillaries in thumb, first toe, ear lobe, and nose.

Measurements of blood flow rate in the pulp of the thumb, the first toe, the ear lobe, and the nose were performed using the heat-washout method, and the 133Xe-washout method under orthostatic changes in humans. Blood flow rate measured by the heat-washout method in the thumb was about 127.5 ml (100 g x min)-1 at heart level in two subjects, (n=10), and in the pulp of the first toe in 6 subjects (n=12) 49.3 ml (100 g x min)-1 at heart level. Above heart level blood flow rate decreased with the falling pressure head, and 50 cm below heart level blood flow remained unchanged compared to heart level. The arterioles supplying the capillaries in this region showed autoregulation of blood flow to 50 cm above heart level, but a veno-arteriolar reflex was not present. Blood flow rate in the ear lobe and on the side of the nose showed a similar pattern of reaction, with a blood flow rate in the arteriovenous anastomoses of about 100 ml (100 g x min)-1 in sitting position.

Survival of composite chondrocutaneous grafts by vessel implantation: a study in the rabbit ear model.

Composite chondrocutaneous graft reconstruction or reattachment has limited applicability, is traditionally restricted to small segmental losses, and is dependent on the status of the recipient bed and graft periphery for successful revascularization. Surgical enhancement of composite graft survival was experimentally investigated in the rabbit ear model through transposition and appositional placement of an adjacent vascular pedicle. Fluorescein-derived surface-survival determinations, microangiographic vessel-counting methods, and histologic analysis were used to study the effects of vascular augmentation, pedicle design variations, and angiogenic substance in sixty 8-cm2, full-thickness auricular grafts. A statistically significant survival advantage was demonstrated for the implanted grafts, secondary to perivascular angiogenesis from the implanted pedicle.

Vascularized auricular perichondrium in airway reconstruction: the effects of stenting with and without a mucosal graft.

This study quantitatively examines the effects of laryngotracheal stenting with and without mucosal grafting on chondrogenesis in a rabbit model. Vascularized auricular perichondrium was transferred to a cricothyroid membrane (CTM) defect in three groups of New Zealand white rabbits: group A, CTM defect alone; group B, CTM defect with endotracheal tube stent; and group C, CTM defect with a buccal mucosa graft (BMG) interposed between the stent and perichondrium. The rabbits were sacrificed at 7 weeks for histologic examination and determination of cartilage thickness by digitometry. Chondrogenesis was not significantly affected by stenting (n = 11; 0.719 mm +/- 0.203 mm) or by BMG (n = 12; 0.775 mm +/- 0.203 mm) as compared with controls (n = 14; 0.695 mm +/- 0.216 mm) (P value = not significant). Laryngotracheal stenting and BMG do not adversely influence chondrogenesis in airway reconstruction with vascularized perichondrium in the rabbit model. The application of these principles in human airway reconstruction is discussed.

Direct monitoring of the microcirculation in experimental venous flaps with afferent arteriovenous fistulas.

This study was conducted to determine the survival mechanism of tissue transfers which make use of an afferent arteriovenous fistula. The study was carried out using a rabbit ear chamber method. In the first experiment (n = 34), the rabbit ear was used to create a flap with a central afferent arteriovenous fistula with either dual (n = 28) or single (n = 6) drainage. In the second experiment (n = 6), a flap with a central arteriovenous fistula with single drainage was created as above. The central vein was then ligated in the flap to investigate the influence of the competent venous valve in the central vein. In both the first and second experiments, blood flow was noted in the capillaries and arterioles. This finding was interpreted as meaning that a flap with an afferent arteriovenous fistula is nourished through capillary circulation. It appears that the blood flow can circumvent the competent venous valve to perfuse the distal part of the ear.