[TOTAL RECONSTRUCTION OF CONGENITAL MICROTIA - OUR EXPERIENCE WITH 150 PATIENTS].

AIMS: In this article, we would like to present our experience in total ear reconstruction for microtic ear patients. BACKGROUND: Partial and total ear reconstruction is one of the most challenging reconstruction procedures in plastic surgery. Ear reconstruction is performed in cases of congenital malformations such as anotia or microtia. In addition, the reconstruction can be performed in a variety of other acquired malformation such as burns, trauma or after skin tumor removal. METHODS: A retrospective study was performed. Microtic ear patients who underwent operations between 2000 and 2017 were included in the study. Patients were closely followed for at least one year. Data collection and surgical complications were recorded. RESULTS: A total of 150 patients were operated on; 102 patients were males and 48 were women. For 85 patients, the microtic ear was on the right, for 60 patients on the left and 5 patients had bilateral microtic ears. The age of patients ranged from 8 to 41 years and about 85% of the patients were between 8-12 years of age. The postoperative complications included: partial skin necrosis in 6(4%) patients, infections in 2(1.3%) patients, 12 (8%) of the patients suffered from pneumothorax, hypertrophic scars in the chest developed in 37(24.5%) patients, cartilage exposure in 12(8%) patients, exposed metal sutures in 25 patients(16.6%) and chest deformity in 2 (1.3%) patients. CONCLUSIONS: Auricle reconstruction with autogenous costal cartilage is the most common treatment for microtic ear. Meticulous planning, proper surgical skills and precise sculpting of the anatomical structures are necessary in order to reach a desired outcome and avoid complications.

Framework changes using costal cartilage for microtia reconstruction.

OBJECTIVE: Since a known growth-of-cartilage framework is used for reconstruction of microtia under the Brent technique, we set out to address the behavior of the framework under the Nagata technique. DESIGN: A retrospective analysis of costal cartilage auricular reconstruction procedures. PATIENTS: A total of 28 patients who underwent costal cartilage auricular reconstruction between 1998 and 2005. INTERVENTIONS: Reconstruction of microtia using the 2-stage Nagata technique. MAIN OUTCOME MEASURES: The parameters checked were patient age at the time of reconstruction, follow-up time, and measurements of the auricular framework height and width both at the time of implantation (represented by the template size) and at final follow-up. RESULTS: A significant change in auricular height and width was observed. The height decreased by 3.1%, while the width increased by 4.0%. This change was not influenced by follow-up time. CONCLUSIONS: Auricular reconstruction with the Nagata technique was undertaken when the patients were aged 9 to 10 years, when the auricle had reached nearly its final size. According to our patient sample, it is our opinion that a policy change is unjustifiable.

[Chest wall deformity following rib cartilage harvesting for auricular reconstruction].

Chest wall deformity is one of the potential complications of rib cartilage harvesting for auricular reconstruction. An eight year old boy underwent two stage microtia reconstruction using the 6th-9th costal cartilage for the 3-D cartilage framework. One year later an anterior chest wall deformity was noticed with bulging of the 5th rib, asymmetry of the lower rib cage line and deviation of the lower part of the sternum. The anterior chest wall is made of ribs, sternum and respiratory muscles forming a dynamic structure. By using these pieces of rib cartilage an imbalance is created in which the respiratory muscles pull the edges of the remaining ribs, thereby creating the deformity. It is especially critical during the growth phase. The 3-D CT scan demonstrates the chest deformity. We present a literature review and recommendations on how to reduce the complications when using rib cartilage for auricular reconstruction are presented.

Four parallel flaps for correction of a wide forehead defect.

A simple method for closure of a defect in the forehead area by four parallel flaps along the forehead wrinkle lines is illustrated. The main advantage of this method lies in its simple design, which enables the surgeon to close large defects with no elevation of the eyebrow, while preserving the hairline, and most of the suture lines are parallel to the forehead wrinkle lines.

[Our experience with two stage ear reconstruction of typical microtia].

One of the most difficult reconstructive procedures is the reconstruction of the auricle, since it has a very difficult form to imitate. During the last four decades there have been numerous reconstructive attempts throughout the world especially for cases of microtia. The principle is to build a framework from cartilage that will be used for the reconstruction. A prominent personality in this field is Dr. Burt Brent, who is identified with this challenge. Dr. Brent has established the method of reconstruction in four stages. In order to limit the operative stages Dr. S. Nagata suggested doing the reconstruction in two stages, using a different cartilage framework and elevating the auricle using temporo-parietal fascial flap and skin graft. His method was improved further by Dr. Francoise Firmin. The first stage is conducted at the age of 9-10, during which the ipsilateral rib cartilage is harvested, carved and put together into a cartilage framework and than inserted into a skin pocket in the area awaiting reconstruction. Half a year later, the auricle is elevated by inserting a wedge cartilage behind it, covering with temporo-parietal fascial flap and skin graft. Our experience using this method in ten microtia cases proves that it is a good choice in total auricle reconstruction for microtia patients.