Objective analysis of microtia reconstruction in Indian patients and modifications in management protocol

Abstract

Introduction:An ideal ear, with representation of all anatomic landmarks, is the aim of any reconstructive surgeon embarking on reconstructing the ear in a microtia patient. The literature is abundant with the description of techniques, but these have been reported mainly in Caucasian and Oriental population. There have been very few publications on results in the population belonging to the Indian subcontinent. In spite of strictly adhering to the recommended techniques of reconstruction, the results obtained in these patients have often been marred by problems that are not reported with the Oriental or Caucasian populations. This may necessitate a relook into the management strategy of these cases. Hindering the assessment of the results, their reporting and auditing the improvement obtained by such change in the management strategy, is the lack of a standardized method for assessment of the outcome. Hence, an attempt was made in a series of patients who underwent microtia reconstruction to assess the outcome using a new tool based on the attained definition of anatomical components of the reconstructed pinna. Further effort was made to document the modifications in the technical execution of the reconstruction during the period of the study.Materials and Methods:A retrospective review of 44 patients and a prospective analysis of 11 patients, who underwent ear reconstruction for microtia from December 2003 to September 2014 at a tertiary care teaching hospital, was undertaken. Taking a cue from Nagata's description of an ‘ideal reconstructed ear’ which should show all the anatomical components, we developed an objective grading system to assess our results. The technique had undergone several changes during these years combining the principles of three universally accepted methods, that is, those described by Nagata, Brent, and Firmin. These changes, as well as the reasons behind them, were documented.Results:On objectively measuring and analysing the replication of normal morphologic characteristics of the reconstructed ears, we documented progressive improvement of our results. Good or excellent results could be achieved in 70% of cases in the second group compared to a poor outcome in more than 2/3rd of the cases carried out during the initial period. Based on these results and the changes adopted in our practice we propose suggestions for management of microtia cases in the Indian population.Conclusions:An objective, weighted grading system has further enabled us to critically evaluate the outcomes and to further improve upon the existing results. Our amalgamation of the salient features of the established techniques as well as changes made based on our experience has enabled us to get good results more consistently in our attempts at microtia reconstruction. We believe that the adoption of such amalgamated methods will be more suitable in Indian patients.

Novel Classification of Posttraumatic Ear Deformities and its Surgical Management

“…Residual ear helps in maintaining elevation of the ear but results in abnormally appearing junction between normal and reconstructed ear, and could have been avoided by using stainless-steel wire sutures. 9 Datao et al (2016) in their study reported about this problem in two patients (one with type II and the other with type III defect). 4 Four of our patients complained about abnormal ear contour, projection of ear, and ear size in comparison to the opposite ear.…”

Microtia Reconstruction: Our Strategies to Improve the Outcomes

“…Achieving an aesthetically satisfactory result depends on having a well-sculpted framework covered by a thin and vascular skin flap. Over the past 7 years, our approach toward management of microtia has evolved with respect to timing of procedure, 12 and technique and management of postoperative complications.…”

Auricular Retentive Prosthetic Conformer Post Brent's Stage III Surgery in Microtia Repair: A Clinical Report

“…The lobule was transpositioned, and the framework was elevated by placing a full thickness skin graft taken from the lower abdomen . One of the limitations of Brent's technique is that there is obliteration of the skin graft into the postauricular sulcus . To prevent the skin graft from contracting and flattening onto the postauricluar sulcus, an auricular retentive prosthesis was fabricated.…”

“…14 One of the limitations of Brent's technique is that there is obliteration of the skin graft into the postauricular sulcus. 13,15 To prevent the skin graft from contracting and flattening onto the postauricluar sulcus, an auricular retentive prosthesis was fabricated. The prosthesis had two components-one that adapted into the postauricular sulcus covering the helix and the other continuing into the external auditory meatus.…”