Ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia / 中华整形外科杂志

Objective@#To explore the curative effect of ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia.@*Methods@#Four cases (six ears) were corrected by ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty method from 2016 to 2017. Following ear release, the flap is rotated into the defect and donor site covered by a razor-thin graft raised in continuity with the flap, the posterior flap was advanced and sutured with Z-plasty.@*Results@#All corrected auricles four cases (six ears) were followed up from 3 months to 1 year and abtained satisfactory and stable appearance.@*Conclusions@#The shape of auricle is natural and satisfactory after operation. The method is simple and no skin grafting is needed. The adhesion of the hidden muscles and cartilages were sufficiently released.

Treatment and outcome of postoperative infection of rib cartilage framework in ear reconstruction / 中华整形外科杂志

Objective@#To investigate treatment and outcome of rib cartilage framework in ear reconstruction.@*Methods@#12 cases of rib cartilage framework infection in ear reconstruction were retrospectively analysed in the latest four years. Lab examination results showed that staphylococcus aureus were found in 5 cases, coagulase negative staphylococcus in 3 cases, Klebsiella pneumonia in 2 cases, aeromonas hydrophila in 1 case and no bacteria were found in 1 case with regular culture. Debridement, systemic antibiotic therapy, saline irrigations and unobstructed drainage were utilized to treat the infection.@*Results@#The average duration of dressing change was 35 days in 12 cases (12-67 days), of which six cases were cured leaving no obvious or mild change of cartilage framework. Cartilage framework was totally damaged by infection in one case, so the framework had to be removed and debridement was then carried out to control infection. Secondary repair should be taken at least 6 months later. In the rest 5 cases, frameworks were taken out in the early stage of infection. The infected portion of the cartilage was removed and the healthy part was buried subcutaneously in the chest. The expanded postauricular flap and fascia were smoothened. Secondary repair should be performed after 6 months.@*Conclusions@#Effective debridement, irrigations and drainage can be used to control infection of cartilage framework and maintain normal contour and structure of reconstructed auricle. With regards to severe infection, framework should be removed as early as possible and infected portion of cartilage should be cleared out, while healthy part could be used for secondary reconstruction of auricular contour after complete control of infection.

[Preliminary clinical research with thoracic deformities in microtia].

OBJECTIVE: To investigate the characteristics and incidence of the thoracic deformities in patients with microtia. METHODS: In Plastic Surgery Hospital, we conducted a retrospective study of the clinical and radiographical data of 300 patients with microtia from March 2013 to October 2014. Pearson χ2 test was used to analyze the relationship among deformities of ribs and spine, as well as microtia. RESULTS: A total of 78 (26.0%) patients were documented with rib deformities, 26 patients (8.7%) had spinal deformities, and 17 patients (5.7% )had both. The incidence of rib deformities in microtia I, II, and III was 7.1% (2/28), 26.7% (62/232) and 35.0% (14/40) respectively. The incidence of spinal deformities in microtia I, II, and III was 3.6% (1/28), 6.5% (15/232) and 25.0% (10/40 respectively. The patients with microtia III were found to have a higher incidence of ribs and spinal deformities than those with microtia II, patients with microtia II were found to have a higher incidence of ribs and spinal deformities than those with microtia I (P < 0.05). CONCLUSIONS: The incidence of ribs and spinal deformities is high in patients with microtia. The poorer one auricle developed, the higher the incidence of thoracic deformities.

[Expanded post-auricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia].

OBJECTIVE: To explore the clinical effect of the method by using an expanded post-auricular skin flap combined with autologous rib cartilage framework for correction of concha-type microtia. METHODS: The operation were performed in three stages. The expander was implanted under post-auricular skin at the first stage and expanded skin flap was formed. At the second stage, the expander was taken out and the expanded skin flap was transferred with autologous rib cartilage framework and skin graft for correction of microtia. At the third stage, the reconstructed ear was revised and new concha was formed. RESULTS: From August 2008 to August 2011, 108 cases with 113 concha-type microtia were corrected by this method. All patients healed primarily and were followed up for 6 months to 3 years. The reconstructed ears had a good appearance and position, and were symmetric to ear on the healthy sides. CONCLUSIONS: Using expanded post-auricular skin flap combined with autologous rib cartilage framework is a reliable method for concha-type microtia.

Reconstruction of large vermilion defects with buccinator myomucosal flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate a novel method for the reconstruction of large vermilion defects.</p><p><b>METHODS</b>Based on the size and shape of the defects, a buccinator myomucosal flap pedicled with the junction of buccinator and orbicularis oris in the oral commisure was designed and rotated to reconstruct the large vermilion defects. The upper bound of the flap is at least 1 cm away from the stensen's duct. The width is about 2.5-3.0 cm, and the length is as far as to arrive the raphe pterygomancibularis. The donate site is directly closed primarily. There is no need for secondary pedicle division.</p><p><b>RESULTS</b>From July 2003 to April 2013, 14 cases with large vermilion defects was reconstructed with this method. No flap necrosis occurred with primary healing. 5 cases were followed up with an average follow up period of 1 year (0.5-3 years). The apprearance and function of the reconstructed vermilion were satisfactory without any apparent donor site defect. The patients were satisfied with both the functional and cosmetic results.</p><p><b>CONCLUSION</b>The buccinator myomucosal flap is a simple and ideal method for reconstruction of large vermilion defects, especially for the defects closed to the commisure.</p>

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.

"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.

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.

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>

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>