Modified Two-stage Operation In Total Auricular Reconstruction With Autogenous Rib Cartilage

Background:According to the reports, the prevalence of congenital microtia in China is 1.4/10000. Based on the most people in the world, the number of the microtia is also large. The ear is an important organ composed the face, so it certainly will bring negative effect to the patients in their mentality, self-confidence and sociality because of the lack of the ear. Giving the ear back to the patients can satisfy their urgent demands. The modern method of auricular construction is first described by Tanzer in 1959. This method not only gives the patients similar appearances of the ear, but also lays the first stone for later auricular construction. Firstly, he insisted on fabricating the ear framework with the autogenous rib cartilage. The autogenous rib cartilage is still considered as the gold standard of surgical reconstruction now. Secondly, he described the procedure of four-stage reconstruction. With this method, his reconsructed ears not only had normal auricle three-dimensional structure, but could withstand the pressure of life. Finally, he opened up a new era of auricle construction. Because others have refined these techniques to the current practice standards. But this method is the four-stage procedure; the long process severely tests the patients' endurance and economic strength. Considering this problem, the scholars invented two-stage and one-stage methods to reconstruct the ear. Typically, Japanese scholar Nagata proposed two-stage method to complete the auricular construction. After several decades of clinical application, this method had good effect. So many plastic surgeons all over the world accepted this method. But this method could greatly increase the younger patients' incidence of chest deformity, because it needed a lot of cartilage. On the other hand, for patients with lower hairline, the hair would grow on the helix of the reconstructed ear, because the skin of the mastoid region is limited. To solve this problem, the scholars applied the expanders to the auricular construction. The application of expanding retroauricular skin fascia flap in China got a good operation effect, typically Zhuang Hongxing team. This method made great demands on the operation skill, and needed 3-stage operation to achieve satisfactory operation effect. So we promoted the two-stage method based on related literature and apply this method to the operation. After six-year clinical application, this method achieves a good operation effect.ObjectiveTo discuss the clinical efficacy of two-stage operations for total reconstruction of auricle, furthermore to summarize the clinical experience about this method.MethodsFrom 2005 to 2010,146 patients (155 ears) with congenital microtia underwent two-stage operations for auricular reconstruction. The first stage involved fabrication and grafting of autogenous rib cartilage, removing the remnant ear cartilage, embedding the framework into local flap of the mastoid region, transferring the remnant ear lobule flap to link to the inferior framework. The second stage was lifting the ear. The ear was elevated using an incision approximately 5mm posterior and superior to the helical rim. With the ear elevated, the crescent-shaped banked graft was fixed beneath the framework in a position comparable to the posterior conchal wall. The bare cartilage was then covered with postauricular fascial flap and skin graft.ResultsAfter the follow-up of 6m-2y, all of 148 constructed ears were satisfied with the results, including good shape and steady auriculocephalic angles.4 cases of partial skin flap necrosis were caused by pedicle impairment. With carefully changing dressings, they were healed. Exposure of cartilage framework happened in 1 case. After transferring the local flap to cover the exposed cartilage framework, it was healed. The auriculocephalic sulcus of 2 cases diminished 6 months after the second stage operation. No infection and absorption of cartilage framework occurred. ConclusionsAccording to our 6-year clinical experience, this method is simple relatively, and has fewer complications. So this method should be considered as an ideal procedure.