| Objective:To evaluate the effectiveness?safety and feasibility of unsymmetrical sculpture's application in the ear reconstruction with autologous cartilage through comparing the difference of the balanced sculpture and unsymmetrical sculpture and evaluating the clinical outcomes of two methods in refining the delicate structures of the reconstructed ear(that is the definition)?shape?size?colour and projection.Method:We use the method of retrospective survey and classify the patients who have undergone ear reconstruction because of microtia into two groups.Group A includes the patients who have undergone operation with the application of balanced sculpture method.Group B includes the patients who have undergone operation with the application of unsymmetrical sculpture method.From June of 2013 to December of 2015,we pick out 35 patients concluding 19 patients of group A and 16 patients of group B according to our grouping criteria and exclusion criteria.Record the number of cases with complications,such as pneumothorax?hemopneumothorax?collapse of framework?exposure of cartilage?necrosis of skin flap and reconstructed ear infection.Then analysis the results.Every patient had at least 8 pictures concluding 8 position sides: the front side,the anterior-right/left oblique side,the lateral side,the posterior-right/left oblique side and the back side.All the pictures were taken according to a uniform standard and laterly were processed only with the ear/reconstructed ear left eliminating the recognizable face features such as the eyes and nose.We evaluate the definition ?shape?size and colour through the anterior-right/left oblique side pictures and the projection through the posterior-right/left oblique side.The evaluation employed a Wilcoxon signed-rank test.One point means poor,two point means relatively bad,three point means general,four point means relatively good,five point means excellent.The 35 patients and their pictures were randomly numbered.Then we selected 3 professional microtia plastic surgeons to evaluate the pictures.All the results were analyzed through the Mann-Whitney U test using the software IBM SPSS Statistics version 19.0.The results were showed as Mean±SD,?=0.05,we regard P<0.05 as significant.Result: Both group A and group B had no pneumothorax and hemopneumothorax;group A had 2 cases which experienced skin flap necrosis,one of them had cartilage exposure and then had secondary infection leading to local cartilage necrosis and absorption,but after active treatment and local skin flap transplantation it was cured.Group B had no pneumothorax?hemopneumothorax?skin flap necrosis?cartilage extrusion ?framework deformation and torsion?framework collapse and necrosis or absorption.The scores of each items are shown as following: Group A: definition: Mean ±SD 2.583±0.809;shape: Mean ±SD 2.556±0.8893;size: Mean ±SD 3.194±0.8426;colour: Mean ±SD 2.806±0.5975 projection: Mean ±SD 3.528±0.4363 Group B: definition: Mean± SD 3.500±0.5774;Shape: Mean ±SD 3.281±0.5468;Size: Mean± SD 3.656±0.5391;Colour: Mean ±SD 3.531±0.3860;Projection: Mean± SD 4.000±0.4472.The P value in definition is 0.001,in shape is 0.008,in size is 0.049,in colour is 0.000,in projection is 0.007.We regard the differences in definition?shape?colour and projection are significant.Conclusion: 1.Both group A and group B had a low rate of severe complications,both of them can be regarded as secure and reliable.2.Group B had a better mean scores in definition?shape?colour?size and projection.The difference in the definition?shape?colour and projection is significant.3.The method of unsymmetrical sculpture can improve the clinical outcome and it looks like safe and reliable for now. |
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