Application Of Total Auricular Reconstruction With Expander In Correction Of Congenital Microtia

Objective: To explore a surgical approach based on the combined use of expandertechnology and autologous costal cartilage transplant for the correction of congenitalmicrotia, that is a total auricular reconstruction including three stages: in the first stage,the ear skin was expanded by using skin soft tissue expander; in the second stage, afterthe removal of expander and the preparation of ear cartilage framework, the expandedskin flap was implanted for the formation of reconstruction auricle; at the third stage,the new ear was repaired in detail, including deepening of auricular concha cavity,reconstruction of tragus and earlobe.Methods: A total of276patients with congenital microtia were admitted into thePlastic Surgery Department at Xijing Hospital of Fourth Military Medical Universityfrom Apr,2012to Feb,2013, including197male and79female cases,162cases withright side microtia and108cases with left side microtia and6cases with bilateralmicrotia, aged between7to33years with an average age of16.7years. At the first stageoperation,“Weining”80ml reniform skin soft tissue expander was used and embeddedat the top of the residual ear;after surgery,normal saline was injected regularly,quantitatively and discontinuously for2-3months of continuous expansion; at thesecond stage operation, after the removal of expander, cutting and carving of the costalcartilage, the expanded skin flap was implanted for the formation of main structure ofthe reconstruction auricle; at least3months after the second stage operation, the localrepair surgery was taken depending on the shape of reconstruction of auricle, such asdeepening of auricular concha cavity, reconstruction of tragus and earlobe with theresidual ear tissue, thereby completing the whole procedure of total auricular reconstruction.Results: The patients were followed up for2months to3years: at the first stageoperation, after the embedment of skin soft tissue expander, there were4cases ofexpander exposure,1case of infection,1case of hematoma and1case of adverseexpansion; after the second stage operation, there were3cases of ear hematoma,1caseof infection,12cases of cartilage exposure,1case of chest hematoma, and no poorblood circulation or necrosis of skin flap; after the third stage operation, there were2cases of cartilage exposure, and no infection or hematoma. Among the patients withpostoperative complications, in addition to the patients with infection who got damagedshape of ear cartilage framework due to poor infection control after the second stageoperation, the remaining patients recovered well after symptomatic treatment and nogreat impact on effect of surgery were caused by complications. Except for the patientsgot infection after the second stage operation, who need to take secondaryreconstructive surgery, all the other patient got good reconstructive ears with vividthree-dimensional structures, similar shape and angle of bilateral ears, and their familieswere basically satisfied.Conclusion: This method is safe and economic and can be widely used in thecorrection of congenital microtia, which also has simple operation, low-risk and fewercomplications that are easy to handle. The ears reconstructed through this surgery canachieve clear three-dimensional structure, uniform skin color and texture, which alsohave similar shape, position and angle with the normal ear; in addition, the satisfactionof patients and their families on surgical effect is high.