A study on psychosocial behavioral outcomes of microtia children and their parents after microtia reconstruction / 中华整形外科杂志

Objective@#To explore the psycho-social and behavioral outcomes of microtia children and psychological health of their parents after microtia reconstruction, and to observe the effects of microtia reconstruction on the psycho-social health of microtia children and their parents.@*Methods@#72 patients were recruited and investigated for their psycho-social behavioral problems with Achenbach′s Child Behavior Checklist (CBCL). Their parents were investigated for psychological health with symptom checklist 90 (SCL-90). The patients and their parents were both assessed with questionnaire before the after operation (6 to 12months post-operation).@*Results@#After microtia reconstruction, the scores of CBCL and SCL-90 decreased significantly.①As determined from CBCL, after operation the scores of activity and sociality ability of the patients increased with significant difference in statistics (P<0. 01). The behavioral problems raw scores were lower than that of pre-operation. The percentage of behavioral problems of the microtia children decreased significantly compared with that before operation, it was significant in statistics (P<0. 01). ②As determined from SCL- 90, it is found out that the general scores and the number of positive items of the parents with microtia children decreased with significant difference in statistics (P<0.01). The scores of SCL-90 factors decreased with a significant difference in statistics (P<0.05).@*Conclusions@#There was significant improvement in the psycho-social behavioral outcomes of microtia children and their patients after microtia reconstruction. There is a positive effect of microtia reconstruction on microtia children and their parents.

Aesthetic and functional restoration of anterior neck scar contracture using a bipedicled expanded forehead flap.

OBJECTIVE: The study aimed to explore a new method to restore functional and cosmetic outcomes for anterior neck burn scar contracture. METHODS: Tissue expanders were implanted subcutaneously under the muscle of the forehead. Tissue expansion started 1 week postoperatively. When the skin expansion finished, a bilateral pedicled expanded skin flap was created on the basis of the superficial temporal artery and transferred to the anterior neck. Both the range of motion of cervical spine and the mental cervical angle were measured before and after operation. Data were analysed by Statistical Package for Social Sciences (SPSS) 13.0 and t-test. RESULTS: From September 2006 to May 2010, six male patients were treated by this method. The active range of motion of the neck of patients improved, the postoperative ranges of active flexion, extension, left flexion, right flexion and left and right rotation of cervical spine increased respectively. The mental cervical angle was 152.7±1.9° preoperatively and 90.7±2.2° postoperatively; the physiological angle was recovered. Patients were followed up from 5 months to 3 years, they were satisfied with the results and no recurrence of contracture was found. CONCLUSION: The bipedicled expanded forehead flap, which provided good blood supply, repaired anterior contracture in the neck and created both aesthetic and functional results; it also diminished donor morbidity.

Post-traumatic ear reconstruction using postauricular fascial flap combined with expanded skin flap.

INTRODUCTION: Post-traumatic ear reconstruction still remains a great challenge for plastic surgeons. In this article, we present the technique of post-traumatic ear reconstruction using a postauricular fascial flap combined with an expanded skin flap. METHODS: From May 2007 to June 2009, 91 cases of post-traumatic ear defect were treated using a postauricular fascial flap combined with an expanded skin flap. Surgical procedure included postauricular-skin-flap expansion, removal of tissue expander, autogenous rib-cartilage-framework implantation, postauricular-fascial-flap lifting and split-thickness free-skin grafting. RESULTS: With a follow-up duration of 6 months to 1 year, the described technique provided a nice final result, and the reconstructed ears showed good match in size, shape, colour and location to the contralateral normal ear. CONCLUSION: Post-traumatic ear reconstruction using a postauricular fascial flap combined with an expanded skin flap is an ideal approach with good final results.

Experience of correction of prominent ears.

OBJECTIVE: To introduce our experience of correction of prominent ears by ear cartilage-folding method, which amalgamates some well-known techniques. METHODS: Preoperative design was in a routine way. The anterior area of antihelix was dissected subcutaneously, and the surface of the cartilage was scored thoroughly. Satisfactory antihelix was established by folding with mattress suturing. One strip of skin was removed from the back of the concha with suture of the remaining cartilage to the mastoid periost to decrease the auricle-mastoid angle. RESULTS: Fifty-nine cases of prominent ears were followed up postoperatively from 1 to 24 months, and almost all of the ears achieved satisfactory effects. Both the antihelix and auricle-mastoid angle were improved markedly. CONCLUSIONS: Not only is this technique reliable, but it also has low recurrence.

Prevention and treatment of rupture and infection in expanded flaps during auricular reconstruction.

OBJECTIVE: To analyze the risk factors of infection and necrosis of expanded postauricular flaps during auricular reconstruction and to provide effective management strategies for complications in expanding postauricular flaps. METHODS: Data were gathered retrospectively for cases of partial rupture and infection of expanding postauricular flaps from the 58 cases of patients undergoing auricular reconstruction after preliminary tissue expansion. Treatment included the following: (1) auricular reconstruction with autologous costal cartilage framework immediately (28 cases); (2) stretching the expanded postauricular flap and fixing in place after expander removal (15 cases); (3) removal of the expander and reinsertion of a similar expander more than 6 months after the wound had healed (12 cases); and (4) continuing expansion after antibiotic treatment (3 cases). RESULTS: Each method was applied to different types of cases. Most cases obtained a satisfactory contour and profile of the reconstructed auricle. CONCLUSIONS: Some individual and risks factors are involved in infection and rupture of expanded postauricular flaps, which can be prevented and minimized. An optimal method can be chosen to treat every case of infection and partial rupture of the expanded postauricular flap.

Using a remnant ear to reconstruct the tragus in total ear reconstruction.

Although the tragus is a small part of the auricle, it is necessary for a reconstructed ear because the excavated conchal region looks quite like a meatus when a prominent tragus casts a shadow on it. To our knowledge, there have been very few reports that specifically address tragus reconstruction. This article discusses various techniques and provides detailed knowledge regarding tragus reconstruction. According to various sizes, shapes and location of the remnant ear, the following methods have been used to reconstruct the tragus. (1) Inversion of a W-shaped skin flap; (2) modifying the concavity of the conchal trace to the convexity of the tragus; (3) obtaining a cartilage-containing composite graft from the remnant ear. At follow up between 3 months and 2 years, most reconstructed tragi have a satisfactory appearance and projection. These methods have proved to be extremely safe, simple and practical, justifying their wide use.

"Implication of technique of ""two-flap"" in ear reconstruction" / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the technique of two-flap in ear reconstruction.Method:Quantitative tissue expansions were used in the mastoid area in the first stage.After the final injection,there was 1 month of sustaining time.Expanded skin flap and unexpanded fascia flap were designed in the second stage,so thetwo-flaptechnique was used in the ear reconstruction.From January 2004 to December 2008,1 427 patients of microtia were treated using two-flap technque.Result:The expanded skin flap could show the fine structures of the reconstructed ears.The reconstructed ears had vivid cranioauricular angle after using the unexpanded fascia flap.Conclusion: Two-flap method was easily manipulated and the complications were rare.The reconstructed ears had lucid and three-dimensional contour.

The application of individual earmuffs in microtia reconstruction using tissue expander / 中国实用护理杂志

Objective To explore the protective affect of individual earmuffs in microtia reconstruction using tissue expander.Methods 95 patients performed the implantation of tissue expander had been grouped into the experimental group(49 cases)and the control group(46 cases).Patients in the experimental group wore individual earmuffs,whereas patients in the control group wore traditional earmuffs.The survey including the information of patients' experience in wearing the earmuffs was carried out on the day when patients were given auricular reconstruction.Data collected from the two groups were analyzed to evaluate the aspects of permeability and safety.Results Patients in the experimental group complained less discomfort in sultry in permeability and tinnitus than patients in the control group.From the perspective of safety,there was no complaints of mosquitoes climbing into the earmuffs from the two groups.Because of the good adhesiveness of the individual earmuffs to the skin,the incidence of redness of skin in the experimen tal group was significantly lower than that in the control group.Conclusions Individual earmuff is a safe and comfortable nursing appliance which is practical for clinical application because of its good permeability,adhesiveness and less incidence of redness of skin.

Implication of technique of "two-flap" in ear reconstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the technique of "two-flap" in ear reconstruction.@*METHOD@#Quantitative tissue expansions were used in the mastoid area in the first stage. After the final injection, there was 1 month of sustaining time. Expanded skin flap and unexpanded fascia flap were designed in the second stage, so the "two-flap" technique was used in the ear reconstruction. From January 2004 to December 2008, 1427 patients of microtia were treated using "two-flap" technique.@*RESULT@#The expanded skin flap could show the fine structures of the reconstructed ears. The reconstructed ears had vivid cranioauricular angle after using the unexpanded fascia flap.@*CONCLUSION@#"Two-flap" method was easily manipulated and the complications were rare. The reconstructed ears had lucid and three-dimensional contour.

Technical innovations in ear reconstruction using a skin expander with autogenous cartilage grafts.

Pioneers such as Tanzer and Brent have established the foundations of microtia reconstruction using an autogenous costal cartilage framework. The framework and its skin coverage are the two limiting factors in ear reconstruction. At the present time autogenous rib cartilage and mastoid skin are still first choice materials for most surgeons. They have the combined advantages of well-matched texture and colour. To reconstruct a symmetrical, accurate, prominent auricle and minimise as much as possible the chest wall deformity caused by rib cartilage harvesting, we set out to improve our techniques for cartilaginous framework definition and to use the remnant ear to enhance the projection of the reconstructed ear. Since 2000, 342 cases (366 ears) were treated using our current techniques. Data pertaining to complications were recorded. Final results were assessed a minimum of 1 year postoperatively. The follow-up period ranged from 1 to 6 years. Most of the patients with microtia were satisfied with the results of their ear reconstruction. In conclusion, our techniques help to reduce the quantity of rib cartilage needed to fabricate ear framework and minimise chest wall deformity. The frameworks are accurate, prominent and stable. Reconstructed ears are similar in colour and appearance to the normal side. Our innovations are practical and reliable for microtia reconstruction using skin expanders in combination with a sculpted autogenous rib cartilage framework.

An investigation of psychological profiles and risk factors in congenital microtia patients.

OBJECTIVES: Among congenital deformities, microtia is often said to be one of the most difficult for the reconstructive surgeon. However, few reports have investigated patients' and their families' psychological profiles. This study sought to determine the prevalence of mood disorders among patients with microtia and to explore clinical features associated with mood disorders. METHODS: Congenital microtia patients were interviewed about Symptom Checklist-90 (SCL-90) and the Achenbach Child Behavior Checklist (CBCL), gender and age of patients, severity of malformation, first perceived age and approach to deformity, being teased by peers, education level of parents, family harmony or not, emotional impact of un-repaired microtia on parents and attitudes of family to patients. RESULTS: The prevalence of mood disorders among microtia patients: 'depression' 20.2%, 'interpersonal sensitivity/social difficulties' 36.6% and 'hostility/aggression' 26.3%. Multivariate analyses suggested that age of patients, severity of microtia, low levels of maternal education, being teased by peers, family disharmony, psychological impact on parents and overprotection from parents are significantly associated with mood disorders of patients. CONCLUSION: Our findings suggest that microtia patients exhibit three significant mood disorders including depression, interpersonal sensitivity/social difficulties and hostility/aggression. Some risk factors should be actively prevented and controlled, such as being teased by peers, family disharmony, psychological impact on parents and overprotection from family.

vrk1 gene mutation test in two Chinese pedigrees of the first and second branchial arch syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the role of vrk1 gene in two Chinese pedigrees of the first and second branchial arch syndrome.@*METHOD@#Sixty members in 2 Chinese pedigrees were recruited. The exon 2 -13 were analyzed by polymerase chain reaction and direct sequencing.@*RESULT@#We found a new SNP in proband of Shandong pedigree.@*CONCLUSION@#vrk1 gene mutation can be excluded in 2 Chinese pedigrees of the first and second branchial arch syndrome.

Subtotal ear reconstruction for correction of type 3 constricted ears.

Constricted ears are characterized by four features: (a) lop deformity, (b) protrusion, (c) low ear position, and (d) decreased ear size. These deformities, resulting from inadequate length of the helix, have been described by Tanzer (1975) as a purse-string closure of the ear. Constricted ears are classified into types 1, 2, and 3 according to the severity of the deformity. Type 3 constricted ear, the most severe, with decreased size and loss of the upper half of the normal ear contour, is classified currently as a mild form of microtia. Therefore, autogenous rib cartilage was used to reconstruct the affected ear much as in correction of microtia. The expanded skin flap in the mastoid area was used to reconstruct auricles for 14 patients with type 3 constricted ear in the authors' center from 2001 to 2004. All the patients were satisfied with the final results. Therefore, the authors conclude that their operative technique is practical and reliable.

A new method for correcting type I and type II constricted (cup and lop) ears.

Tanzer suggested the term "constricted ear," denoting a spectrum of deformities limited to the superior third of the ear. Tanzer classified the constricted ear into three types. Type I ears have involvement of the helix, which usually is flattened. Type II ears show involvement of both the helix and the scapha. With type III ears, the auricle is rolled into a nearly tubular form that some authors regard as a form of microtia. The authors' new method for correcting the constricted ear varies in accordance with the diverse degree of deformity. The new method was used to correct constricted ears through a one-stage operation in eight type I cases. For the remaining six type 2 cases, the methods were combined with composite grafting. Most of the patients were satisfied with the final results. Therefore, the authors conclude that their approach is suitable for the treatment of type I and type II constricted ears.

Surgical depilation in low hairline aurical reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>Low hairline is one of the most troublesome problem in auricle reconstruction. There was no satisfactory way to manage the problem. This article discuss surgical depilation to deal with this problem and reconstructed auricle.</p><p><b>METHODS</b>According to the degree of the low hairline, Postaurical scalp was expanded and part of the lower follicles within the dermal were removed, or postaurical scalp that part of lower follicles and dermal had been removed was expanded and covered skeleton of ear with this expanded skin to reconstructed auricle.</p><p><b>RESULTS</b>Auricles were reconstructed with this method in 152 lowhairline microtial cases, the result was very satisfactory.</p><p><b>CONCLUSION</b>This procedure is an effective way to deal with low hairline in reconstructing auricle.</p>

Treatment of large-sized auricular nevus through split-thickness skin grafting over perichondrium / 中华医学美学美容杂志

Objective To investigate the effect of treatment for la rg e-sized auricular nevus through split-thickness grafting over perichondrium. Methods In the six cases with large-sized and giant cong enital melanocytic nevi of the auricle, the auricular lesions were radically exc ised in stages, and each time followed by split-thickness skin grafting. The ou tcome was evaluated. Results The grafts completely surviv ed. During the time of follow-up ranging from one to two years, the grafts expe rienced no contraction, and auricular deformity did not occur. Conclu sion Treatment of large-sized auricular nevus through staged split -thickness skin grafting over perichondrium is simple and reliable.

Histological and biochemical comparison of residual ear cartilage between microtia patient and normal counterpart / 中华医学美学美容杂志

Objective To investigate the biochemical differences between the cartilage of the residual ear of microtia patient and normal person. Methods Seven cartilage specimens from 7 about 10-years-old microtia patient's residual ears and 7 normal ears from cadaver of the same age were measured by electrophoretic mobility shift assay and spectrophotometer for collagen glycoaminoglycan (GAG), chondroitin sulfate (Chs), hyaluronan (HA) and keratin sulfate (KS) .Results Biochemical analysis showed that no significant difference were found in the collagen contents of the two groups. The microtia cartilage had more GAG (49.00?25.60) ?g/mg than that of the normal (28.25?4.80) ?g/mg. The composition of GAG were different between two groups: microtia group (HA 38.96+4.97 %, Chs 29.02 %?4.12 %, KS 32.16 %?7.41) % and normal group (HA 32.94 %?3.24 %, Chs 33.10 %?2.61%, KS 33.96 %?1.66 %). There were differences in HA and Chs relative contents, but not in KS between the two groups. Conclusions There is no difference in the collagen content between normal and microtia ear cartilage. But the latter has more GAG than the former. As for the constitution of GAG, microtia cartilage has a higher percentage of HA, lower percentage of Chs, and no significant difference in KS.

Reconstruction of the external ear utilizing expanded scarred skin flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of ear reconstruction using local expanded scarred skin flap.</p><p><b>METHOD</b>We used local postauricular expanded scar skin flaps to reconstruct external ear in 24 patients.</p><p><b>RESULTS</b>Of these cases, 22 flaps survived completely. In 2 patients, the cartilage framework exposed over the upper pole of helix region because of undue tension in suturing the tissue edges. One year's follow-up revealed satisfactory results.</p><p><b>CONCLUSION</b>Using the expanded scarred skin flap for ear reconstruction is practical and effective, when there's no normal skin available in the local area.</p>

Effects of substance P on expression of apoptosis-associated genes in fibroblasts derived from pathological scars / 解放军医学杂志

Objective To investigate the effects of substance P (SP) on the expression of apoptosis-associated genes in fibroblasts derived from pathological scars. Methods Fibroblasts derived from keloid, hypertrophic scar and normal skin were cultured separately in media containing SP and SP receptor antagonist. PCNA, bcl-2 and bax protein in fibroblasts were assessed by means of immunohistochemistry. Results SP enhanced PCNA and bcl-2 expression in all three kinds of fibroblasts, whereas, bax expression was inhibited significantly. SP inhibited the expression of bax in keloid scar fibroblasts (KSFB) more remarkably than that in hypertrophic scar fibroblasts (HSFB) or normal fibroblasts (NFB), and the effect was stronger on HSFB than on NFB. SP receptor antagonist could inhibit those effects of SP totally or partially. Conclusion SP may play an important role in the formation of pathological scars by modulating the expression of apoptosis-associated genes, which is mediated by SP receptor.

Tissue engineered neocartilage using polymer substrates and chondrocytes rrom residual ear / 中华医学美学美容杂志

Objective To investigate the possibility of using poly-hydroxybutyate-hydroxyhexate p(3HB-co-3HH)), a modified extracellular matrix, the third generation of PHA family, as a scaffold for seeding of chondrocytes from the residual ear of microtia patients to generate tissue engineered cartilage in athymus mice. Methods The residual ear cartilage from eight 7-years-old microtia patients was enzymatically dissolved by collagenase, and chondrocytes were harvested and seeded into foams of PHB-PHH. After incubation for 1 week in vitro, chondrocyte-polymer constructs were implanted subcutaneously into 8 athymus mice. A control groups was established by subcutaneous implantation of PHB-PHH foams alone. One athymus mice were killed at 4 weeks postoperatively, and 6 were sacrificed at 8 weeks. The specimens were dissected and examined macroscopically and histologically. Results Specimens harvested from chondrocyte-polymer constructs subjected to gross morphologic and histology analysis demonstrated new cartilage formation, and those from control groups showed no cartilage formation. The one of 4 weeks still had some remains of the scaffold with nodules of neocartilage. After 8 weeks, all the 6 mice had neocartilage formed almost the same as natural. The PHB-PHH scaffold were totally absorbed. Conclusion These findings demonstrate that the foam of PHB-PHH is not only a good "matrix" for cartilage tissue engineering, but also optimal scaffold for the seeding of chondrocytes from the residual ear to generate new cartilage that would be useful in plastic and reconstructive surgery. Chondrocytes from the residual ear of microtia patients are good candidates for generation of tissue engineered cartilage.