Three-dimensional Quantitative Standards for Assessing Outcomes of Facial Lipotransfer: A Review.

BACKGROUND: Reliable quantitative data are required to address the unpredictability of facial autologous fat grafting (AFG). Facial evaluation by 3D scanning technology is getting popular. However, this process lacks unified standards and the reliability assessments. This study aimed to summarize a set of standards to improve the 3D quantified reliability of AFG outcomes. METHODS: A systematic review was used to collect the differences in and limitations of 3D assessments and analyze the effect of the quantification process on the AFG outcomes. Healthy subjects undergoing only one facial structural AFG and 3D assessments were included. The revealed specific issues guided the subsequent narrative review that involves 3D measurement and fat volume retention rate (FVRR) analysis. Criteria were formulated based on the narrative review. RESULTS: The systematic review revealed the quantitative process to be operator-dependent. The intra-group FVRR in the postoperative 11+ month group varied significantly (P=.03). The review identified a set of 3D measurement standards, including two optimal software products, two necessary steps for preprocessing, and four testing criteria. We proposed a new calculation formula and parameter and recommended a segmental area analysis for assessing the outcomes of full-face fat grafting. CONCLUSIONS: As far as the 3D evaluation of AFG outcomes is concerned, this is the first study to comprehensively analyze the process and set quantitative criteria. These standards would not only guide future research more reliably, but also provide fresh insight into the review of the past research. 3D measurement standards also apply to all face-related studies requiring 3D registration. LEVEL OF EVIDENCE III: 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 .

[Biomechanical properties of the costal cartilage and its significance in the timing of ear reconstruction].

OBJECTIVE: To investigate the age-related change in biomechanical properties of the costal cartilage and its relevance to the timing of ear reconstruction with costal cartilage framework. METHODS: The patients of 5 to 25 years old were divided into three groups according to their age. The biomechanical properties of costal cartilage harvested from these patients during ear reconstruction were tested, including stree-strain relationship, stress relaxation and creep, tensile strength. All the results were analyzed statistically. RESULTS: The costal cartilage from children group had the best biomechanical properties, while the costal cartilage from the adolescent group had the worst. The difference had a statistically significance (P < 0.05). CONCLUSIONS: The biomechanical properties of costal cartilage are age-related. So it is recommended that ear reconstruction with costal cartilage framework should be performed in childhood when the costal cartilage has the best biomechanical properties.

[Application of residual ear in auricular reconstruction of microtia].

OBJECTIVE: To summarize different treatments of the residual ear in auricular reconstruction, to investigate the reasonable applications of the residual ear. METHODS: From September 2005 to July 2006, 128 patients (79 males, 49 females; aging 5-21 years with an average of 11 years) with unilateral microtia underwent the staged repair. In the patients, there were 44 cases of left-unilaterally microtia and 84 cases of right-unilaterally microtia. The residual ears looked like peanut in 56 patients, like sausage in 35 patients, like boat in 27 patients, and like shells in 10 patients. Among all the patients, the external acoustic meatus was normal in 5 patients, stenosis in 11 patients, and atresia in 112 patients. According to auricular developmental condition, the patients were divided into three types: 17 cases of type I, 98 cases of type II, and 13 cases of type III. In the first stage operation, a 50 mL kidney-liked expander was implanted into post aurem subcutaneous tissue. The residual ear whose superior extremity was close to the hair line was treated. The middle and superior part of the residual ear was cut. The redundant residual auricular cartilage was removed. In the second stage operation, the inferior part of the cartilage frame was covered by the middle and superior part of the residual ear. According to the location of the residual ear, "V-Y" plasty, "Z"-plasty and reversal of the residual ear were used to correct the location of the residual ear. In the third stage operation, the remained residual ear was used to reconstruct crus of helix or cover the wound surface which was resulted from repairing the reconstructed ear. RESULTS: The residual ears which were reshaped and transferred had good blood circulation. All residual ears were survival. The wounds healed by first intention. The follow-up for 8-15 months showed that the auricular lobule of the reconstructed ear was turgor vital is and natural. The locations of the reconstructed ear and normal side ear were symmetry. The auricular lobules of the reconstructed ear survived well. The reconstructed crus of helix, helix, antihelix and triangular fossa were clear. The results were satisfactory. CONCLUSION: Using residual ear reasonably is an important procedure of successful auricular reconstruction and the symmetry of the reconstructed ear and uninjured side ear.

[Clinical study of chest contour deformity after harvesting of costal cartilage for total ear reconstruction].

OBJECTIVE: To investigate the chest contour deformities after harvesting of costal cartilage for total ear reconstruction, so as to prevent donor site morbidity. METHODS: 107 cases of microtia who underwent ear reconstruction with costal cartilage during the period from 1994 to 2003, were retrospectively studied. Both the chest depression deformity and the costal arch deformity were evaluated. The possible related factors to the chest contour deformities were analyzed statistically with Stata software. RESULTS: The incidence of chest depression was 54.55% (48/88), including 35 cases of mild depression (39.77%) and 13 cases of severe depression (14.77% ). The incidence of costal arch deformity was 52.77% (46/88), including 33 cases of mild deformity (37.50%) and 13 cases of severe deformity (14.77%). The incidence of both deformities was significantly different at different age (P < 0.01), but not at different follow-up period (P = 0.294 and P = 0.225, respectively). Gender was related to the incidence of chest depression (P < 0.01), but not to the costal arch contour deformity (P = 0.619). Comparing resection of the 6th and 7th rib cartilage with resection of 7th and 8th rib cartilage, the incidence of costal arch deformity was significantly different (P < 0.01), but the incidence of depression deformity was not (P = 0.657). CONCLUSIONS: The incidence of chest deformities increases with early operation time (< 13 years old). The male patients have higher incidence of depression deformity than female. The arch deformity is higher when the 6th and 7th rib cartilage were resected. The follow-up period is not related to the chest deformities.

[Clinical significance of vascular distribution type of the expanded skin in the mastoid region in congenital microtia].

OBJECTIVE: To classify the blood vessel distribution of the expanded skin in the mastoid region and its relevance to reasonable and reliable design of the expanded flap for auricular reconstruction in congenital microtia. METHODS: The blood vessel distribution of the expanded skin in the mastoid region was observed by light permeation test. The expanded flaps with different ratio of length to width were designed according to their blood vessel distribution types. RESULTS: The vascular distribution of the expanded skin in 403 cases was divided into five types. All the flaps survived completely. CONCLUSIONS: The blood vessel distribution type of the expanded skin in mastoid region has great significance for the design of post-auricular expanded flap in auricular reconstruction.

[Psychological status of congenital microtia patients and relative influential factors: analysis of 410 cases].

OBJECTIVE: To investigate the psychologic status of congenital microtia patients and related influential factors. METHODS: In a cross-sectional survey for congenital microtia, 410 patients, 314 males and 96 females, aged 12 +/- 6 (5 - 37), underwent psychological survey with the symptom checklist-90 (SCL-90) or Achenbach child behavior checklist (CBCL), centering on the 3 main psychological problems: depression, interpersonal sensitivity or social difficulties, and hostility or aggression. A questionnaire was designed to investigate the influencing factors, such as the patients' own factors, and psychological factors of the patients' families Chi square test and logistic regression analysis were performed to find the factors contributing to those psychological problems. RESULTS: Psychological status of congenital microtia patients were depression existed in 83 patients (20.2%), interpersonal sensitivity or social difficulties existed in 150 patients (36.6%), and hostility or aggression existed in 108 patients (26.3%). The factors, such as age (OR = 1.75), microtia grade (OR = 2.77), mother's education (OR = 2.49), having been subjected to ridicule (OR = 2.58), pressure of family affection (OR = 1.96), family attitude to patient (OR = 2.45), and deficiency of family harmony (OR = 2.57) were risk factors contributing to depression of patients. The factors, such as age (OR = 1.62), having been subjected to ridicule (OR = 3.34), and pressure of family affection (OR = 1.89) were risk factors contributing to interpersonal sensitivity or social difficulties of the patient. The factors, such as having been subjected to ridicule (OR = 2.47), and pressure of family affection (OR = 1.80) were risk factors contributing to hostility or aggression of the patient. CONCLUSION: Having been subjected to ridicule, deficiency of family harmony, and pressure of family affection are mainly risk factors of psychological problems of congenital microtia patients. Early education and early operation for the patients are necessary.

[Classification and repairment of "butterfly ear" deformity].

OBJECTIVE: To classify and repair "Butterfly Ear" deformity which presents characters of dysplasia of inferior auricle of ear and congenital bat ear. METHOD: The repairment procedures include: type I: auricular cartilage flap inversion folding technique. type II: local ear skin flap. type III: soft tissue expander autogenous, rib cartilage framework. RESULTS: The method was used in 19 cases from October 2001 to March 2005. Postoperative follow-up showed satisfactory results in all cases. CONCLUSION: According to "Butterfly Ear" deformity classification, different technique could be applied.

[Case control study on risk factors of congenital microtia].

OBJECTIVE: To identify the risk factors associated with congenital microtia. METHODS: A case-control, retrospective study was performed. A total of 207 cases of congenital microtia and 209 age-frequently-matched controls were interviewed individually according to the uniform questionnaire. The questionnaire included: (1) Essential information about patients and their parents. (2) First trimester diseases and medication of mother. (3) Past gestation history of mother. (4) Family history and life style of the parent. The available data were analyzed by chi-square test and multivariate Logistic regression model. RESULTS: The factors, such as gender (OR = 5.893), first trimester disease of mother (OR = 34.49) and medication (OR = 4.299), excessive drinking and smoking of father (OR = 4. 347, OR = 4.304), non-primiparous parity (OR = 9.524), abortion (spontaneous and induced, OR = 1.723), low-education of mother (OR = 2.275) were risk factors contributing to microtia in multivariate study. The factors, such as tea (OR = 0.179) were protective factors in multivariate study. CONCLUSIONS: Multi-risks factors are contributing to microtia. Preventive measures according to risk factors should be put forward.

[Psychologic status and their influencing factors in congenital microtia patients and their families].

OBJECTIVE: To study the psychologic status and their influencing factors in congenital microtia patients and their families. METHODS: Totally one hundred and two congenital microtia patients (79 men, 23 women, mean age 13.62 +/- 7.2 years) were enrolled. The patients and their families answered the questionnaire written by ourselves to identify the psychosocial problems. RESULTS: (1) 23.5% patients were found to have severe psychosocial problems, such as lack of self-confidence, close and fear and so on. (2) With the growth of age, psychosocial problems of the patients were rated high (P < 0.05). (3) For patients who found their deformations early, psychosocial problems also were rated low. (4) For patients who found their deformations by themselves, psychosocial problems also were rated low. (5) The education and psychosocial impact for parents all affected patients deeply. CONCLUSIONS: To prevent psychosocial problems, we should operate for patients as early as possible. And correct guidance is very important for youngsters.