Clinical efficacy of modified total auricular reconstruction technique by using reformative inflation method and remnant ear without skin grafting

Liu, Chuanqi; Wei, Shiyou; Zhu, Guonian; Li, Zhengyong

doi:10.21037/atm-21-1302

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…Several studies in our review devised and explained their own scoring systems, which in some instances even included the use of multiple independent evaluators. 29,40,47,53,66,88 However, none of these scoring systems were reproduced across other studies. This emphasizes the need for a standardized rating tool of aesthetic outcomes, such as the EAR-Q scale, or RHSC and GOSH questionnaires, which have not yet been adopted in the microtia reconstruction literature.…”

Section: Discussionmentioning

confidence: 99%

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Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis

Kim,

Namavarian,

Khan

et al. 2024

Facial Plast Surg

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Objective: Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. Data Sources: A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Methods: Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Results: Sixty-eight studies with a total of 5546 patients used autografts (n=5382) or alloplastic implants (n=164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98% vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95% vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Conclusion: Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis

Kim,

Namavarian,

Khan

et al. 2024

Facial Plast Surg

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“…7 The expansion method usually required 3 to 4 stages of surgery to complete. 8 The first stage operation was to remove the scaffold and smooth the skin flap, the purpose was to reduce the scar tissue as much as possible, and simultaneously made the skin of the operation area as smooth as possible, which usually lasted for about 1 year. If the scaffold was applicable, it could be buried under the skin of the right costal area to prepare for the auricle scaffold in the future, and could be used as a base or part of the scaffold.…”

Section: Discussionmentioning

confidence: 99%

Revision Operation of the Unsatisfactory Microtia Reconstruction With Autologous Costal Cartilage

Huang

Sun

Yang

et al. 2022

Journal of Craniofacial Surgery

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Background: Revision operation of the unsatisfactory microtia reconstruction is 1 of the most difficult revision operations in plastic surgery. This study discussed the cases about revision operation of the unsatisfactory or failed ear reconstruction using autologous costal cartilage and residual. Methods: A prospectively maintained database of all consecutive patients who underwent secondary total ear reconstruction from 2013 to 2020 was reviewed. Demographic data and outcomes were assessed. Results: Thirty-six patients with microtia met the inclusion criteria. The age of the patients who underwent secondary reconstruction ranged 6 to 56 years. The follow-up duration was from 1 to 8 years. Primary reconstruction using costal cartilage was performed in 34 cases, and Medpor (porous high-density polyethylene) were used in 2 cases. All 36 cases were treated with costal cartilage as the revision. One-stage revision was performed in 27 cases, including scaffold covered by superficial temporal fascia flap in 9 cases, retroauricular fascia flap in 12 cases and superficial temporal plus retroauricular fascia flap in 5 cases. Nine cases were renovated with expanders by stages, of which 8 cases were covered by retroauricular fascia and 1 case was covered by expanded skin flap. Complications occurred in 2 cases, and 1 patient was not satisfied with the partial scaffold repair. Conclusions: The effect of revision operation of ear reconstruction with costal cartilage is satisfactory, and different methods of ear reconstruction are indicated in different operation conditions, and the revision surgery requires adequate preoperative evaluation.

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“…Nevertheless, controversies remain among the surgeons regarding the sizes of the distinct hollows inside the scapha and fossa triangularis. Some scholars believed that larger distinct hollows were beneficial to attain favorable aesthetics with better anatomical details ( Zhang et al, 2021 ; Yang et al, 2018 ). In contrast, others considered smaller cavities were conducive to stabilization of the cartilage framework ( Bonilla, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

Zhong

Chen

Zhao

et al. 2021

Front. Bioeng. Biotechnol.

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Skin necrosis is the most common complication in total auricular reconstruction, which is mainly induced by vascular compromise and local stress concentration of the overlying skin. Previous studies generally emphasized the increase in the skin flap blood supply, while few reports considered the mechanical factors. However, skin injury is inevitable due to uneasily altered loads generated by the intraoperative continuous negative suction and uneven cartilage framework structure. Herein, this study aims to attain the stable design protocol of the ear cartilage framework to decrease mechanical damage and the incidence of skin necrosis. Finite element analysis was initially utilized to simulate the reconstructive process while the shape optimization technique was then adopted to optimize the three-pretested shape of the hollows inside the scapha and fossa triangularis under negative suction pressure. Finally, the optimal results would be output automatically to meet clinical requirement. Guided by the results of FE-based shape optimization, the optimum framework with the smallest holes inside the scapha and fossa triangularis was derived. Subsequent finite element analysis results also demonstrated the displacement and stress of the post-optimized model were declined 64.9 and 40.1%, respectively. The following clinical study was performed to reveal that this new design reported lower rates of skin necrosis decrease to 5.08%, as well as the cartilage disclosure decreased sharply from 14.2 to 3.39% compared to the conventional method. Both the biomechanical analysis and the clinical study confirmed that the novel design framework could effectively reduce the rates of skin necrosis, which shows important clinical significance for protecting against skin necrosis.

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Clinical efficacy of modified total auricular reconstruction technique by using reformative inflation method and remnant ear without skin grafting

Cited by 3 publications

References 20 publications

Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis

Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis

Revision Operation of the Unsatisfactory Microtia Reconstruction With Autologous Costal Cartilage

Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

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