| ObjectiveArticles concerning about the exploration and innovative research on the treatment of concha-type microtia were found.Ear reconstruction with autogenous rib cartilage grafting has been recommended by surgeons worldwide as the most standardized methods for treating concha-type microtia.There are many therapy strategies for the concha-type microtia with complicated structures,and different amount of the remnant skin and cartilage.In our clinical work,we found that different severity of the concha-type microtia often corresponded to different therapies and treatment timing.This study was designed to summarize a detailed and individualized treatment strategies for the concha-type microtia.In addition,experimental research was designed to adequately investigate the effects of radial cartilage incision on the ultimate morphology of growing cartilage and to get a strong theory,in order to assist the clinical work.The main objectives of this study are as follows:1.to establish a new classification system and summarize individualized treatment strategies for concha-type microtia based on the clinical data.2.to investigate the anthropometric characteristics of concha-type microtia before and after auricular cartilage unfolding,and to provide references for the surgical indication,therapy timing and prognosis evaluation.3.To explore the effects of early cartilage radial incision on the growth of rabbit ear.Methods1.A total of 424 patients with concha-type microtia underwent individual treatment in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College from January of 2012 to June of 2019.Through systematic review and analysis of the patients’ preoperative,intraoperative,postoperative and follow-up data and the structural characteristics of the concha-type microtia,we made a new classification system and new suitable individual treatment strategy for the concha-type microtia patients.And during the follow-up,evaluation of postoperative aesthetic outcomes was done.2.Retrospective study of preoperative,postoperative and follow-up photos,medical records and three-dimensional scanning data in 33 patients,who underwent individual treatment in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College from January from October 2016 to September 2018.Photos were taken at the preoperative and postoperative time and the affected auricular detailed structures were quantitatively analyzed.The ear width,length and perimeter of the preoperative,postoperative,follow-up time were noted with 3D-scanning technology.Paired sample test was used to analyze the relationship between the affected and the contralateral ears.3.Ten healthy 4 weeks old New Zealand white rabbits(no sex restriction)were selected as the experimental animals.Ear cartilage radial cartilage incision were performed randomly on one ear as the experimental group and the contralateral ear of each rabbit served as the control.To assess morphologic differences between the control and the experimental group,the length,width,and perimeter of each ear were measured every two weeks from 4 weeks old to 22 weeks old.Surface area was calculated at 4 and 22 weeks old.At 22 weeks old,the rabbits were anesthetized again and cartilage was harvested from each ear at an approximate site.Bending stress-strain,compression stress relaxation,tensile stress relaxation and creep were analyzed.The control group received the same operation and biomechanical testing.Statistical analysis was used to comparative analyze the experimental and the control ears.Results1.The classification system consists of four classes of increasing severity,each characterized by progressive changes in the auricular ear size(perimeter),amount of folded cartilage folded,degree of development of scapha,antihelix,superior crus,inferior crus,triangular fossa.Grade I can be treated with radial cartilage incision or free auricular composite tissue grafting.Grade I can be corrected by radial cartilage incision(first-stage)combined with free auricular composite tissue grafting(second-stage).The correction strategy for Grade Ⅲ includes:early wearing of the "ear" auricular deformity correction system within 3 months after birth,at 1-3 years,radial cartilage incision(first-stage)is performed to fully stretch the folded cartilage,and release the remnant ear skin and fibrous tissue surrounding the malformed ear cartilage.Then free auricular composite tissue grafting(second-stage)can be performed to adjust auricle size bilaterally.2.Among the 33 patients,there were 6-9 structures(7.5±1·0)in the affected auricle.After auricular cartilage unfolding,there were 9.5-12 structures(11.3 ±0.8).It increased 2.5-5.0 structures(averaged 3.8).Postoperative structures showed more than preoperative’s in affected ears(paired-samples t test,P=0.000,t=23.279).Average length,width and perimeter increased(P<0.05)after the surgery.At an average follow-up of 17.5 months,the affected and contralateral normal ears all showed changes in ear sizes(P<0.05).The difference values between Postoperative and preoperative affected ears’ length,width and perimeter were(3.13±1.44),(2.44±0.92),(8.50±3.76)mm,the normal sides were(3.16±1.54),(2.35±0.86),(9.79±4.60)mm.No significant differences were found in the average length,width,perimeter growth between the affected and contralateral normal ears.Compared with the preoperative period,5 cases(71.43%)of the children’ parent showed that the relationship between husband and wife had improved.12 parents(70.59%)showed better sleep than before.10 parents(52.63%)indicated that they felt inferior and uncomfortable in public places.In 14 cases(60.87%),the pressure decreased when facing children.13 parents(68.42%)felt anxiety and depression released.3.There were no obviously differences in the overall shapes of the radial cartilage incision’s ears as compared to the controls at 18 weeks(22-week-old).The growth tendencies of the ear length,width and perimeter were observed and analyzed.The growth curves of the experimental ears were similar to the controls’.There no significant difference in the increased ratio of surface area among the two groups(P<0.05).The cartilage of the experimental ears showed no change in biomechanical properties compared to the controls’(P<0.05).Conclusion1.We summarized the new detailed classification system of the concha-type microtia,which can both clearly assess the severity of concha-type microtia and guide the optimal individual treatment strategies.A series of individualized surgical and nonsurgical techniques provide a simple and promising treatment approach for some concha-type microtia patients,such as grade Ⅰ-Ⅱ and part of grade Ⅲ,avoiding rib cartilage harvesting and auricular reconstruction.2.Through early treatment with folded cartilage stretching technique,the Grade II concha-type microtia patients received more ear structures and increased ear sizes,which make it possible for free composite tissue transplantation and relieve parents’ mental stress.In addition,Comparison of the affected auricle and the contralateral normal ear revealed a very similar growth rate and it offers the theoretical foundation for the early treatment for concha-type microtia.3.This study shows that radial cartilage incision at an early age don’t influence the growth of rabbit ear length,width,perimeter,surface area and also don’t change the biomechanical properties of the cartilage. |
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