The Clinical Analysis Of Ear Reconstruction In The Treatment Of Congenital Microtia By Using Exceedingly Expanded With Autologous Costal Cartilage

Objective:This article discussed the operation technique of ear reconstruction by using exceedingly expanded with autologous costal cartilage, including its advantages and disadvantages.Methods:This article is based on the retrospectively study of the124remedy cases of congenital microtia by using excessive expansion method with autologous costal cartilage, admitted by the Plastic Surgery Department at The Second Affiliated Hospital of Kunming Medical University from January2007to April2014. Among the124paticents between7to38years old with an average age of15.35, class Ⅰ was noted in22ears(17.3%) while classⅡ was noted in96ears(75.6%) and classⅢ was found in9cases (7.1%). Futhermore, of the124cases,64.5percent are male while59.1percent female cases. There are73(59.1%) cases with right side microtia,48(38.6%) cases with left side microtia and6(2.3%)cases with bilateral microtia. Surgery is divided into three periods. In the first stage of operation, reniform skin soft tissue expander from50ml to80ml according to the degree of auricle deformity of the patients was used and embedded at the top of the residual ear; And the patients were divided into two groups:the first group is the subcutaneous group, for whom skin soft tissue expander was used and embedded at the top of the residual ear after the subcutaneous.with a total number of38sides; the second group is the fascia group, for whom skin soft tissue expander was used and embedded at the top of the residual ear fascia, with a total number of89sides. One week after surgery, normal saline was injected regularly with the volume between80ml and120ml for2 or3months. In the second stage of the operation, after the removal of expander,depending on the thickness of the skin flap, certain part of fascia subcutaneous tissue formation were eliminated, cutting the cartilage number costal6,7,8, or7,8,9, and then carve them based on the shape and size of the contralateral auricleand Assemble scaffolds. Stainless steel were applied to shapen them and preseve them in the flap pouch prepared in advance. Then place negative pressure drainage tube on them so that negative pressure would form them after the forming of auricle. In the third stage of the operation, no less than3months later after the second stage, the local repair surgery was taken depending on the shape of reconstruction of auricle, such as to deepen of auricular concha cavity, reconstruct tragus and earlobe with the residual ear tissue, and thereby complete the whole procedure of total auricular reconstruction.Results:①In the first stage operation, after the embedment of skin soft tissue expander under127sides and embedment of skin soft tissue expander in subcutaneous38sides, there were2(5.3%) sides of infection,4(10.6%) sides of expander exposure, and2(5.3%) sides of hematoma. Under the embedment of skin soft tissue expander in fascia89sides, there were2(2.2%) sides of infection,3(3.4%) sides of expander exposure, and2(2.2%) sides of hematoma, revealing a statistically significant (P＜0.05) complications comparing the two groups.②In the second stage operation,15(11.8%) sides of complications appeared in127sides. After certain treatment, this way of treatment was unsuitable for5(3.9%) sides while the treatment was continuedto apply to the remaining122sides (96.1%). The second stage of operation having been done, there were2(1.6%) sides of ear hematoma,3(2.4%) sides of infection,4(3.2%) sides of Cartilage exposure,2(1.6%) sides of chondronecrosis, and1(0.8%) sides of pneumothorax,and there was neither poor blood circulation nor necrosis of skin flap. No great impact on effect of surgery were caused by complications. However, the shape of ear cartilage framework and auricle for one side with infection got damaged due to poor infection control after the second stage operation.③After the third stage operation, there was no cartilage exposure or necrosis of skin flap. The patients were followed up for2months to5years. Most of the patients got good reconstructive ears with vivid three-dimensional structures, similar shape and angle of bilateral ears, and their families were basically satisfied.Conclusion:1.The Complication rate was low with skin soft tissue expander used and embedded at the top of the residual ear fascia. It has an great effect on getting enough amount of skin for ear reconstruction2.Autologous costal cartilage was featured with good biocompatibility and no rejection. It is the best choice of material in ear reconstruction after carved into three-dimensional auricle frame.3. The auricle reconstruction by using soft tissue skin expander together with autogenous rib cartilage framework is divided into three periods. It takes more time, and incidence of certain complications may occur. But the ears reconstruction through this surgery can achieve clear three-dimensional structure, uniform skin color and texture, which have similar shapes, position and angle with the normal ear. As a result, patients and their families are more likely to be satisfied. It is the first choice for auricular reconstruction.