Treatment Of Failed Reconstructed Ears

Objective:To discuss the treatment for dealing with the failed reconstructed ears.Methods:From September 30,2014 to September 30,2019,67 cases(67 ears)were admitted to our department because of poor postoperative shape after auricle reconstruction,unsatisfied with macroscopic structure and detailed anatomical structure,and unable to achieve satisfactory results after local dressing.We had to remove the original framework and re-prepare ear framework and perform reconstruction surgery.According to the local skin and soft tissue conditions of the patients,we divided them into 2 categories,4 groups in total,and the surgical methods were also divided into 4 categories:Category 1,34 ears(50.7%),the local hairless skin tissue of the reconstructed ear is sufficient and the skin condition is good.Group 1.1,20 ears(29.8%),the posterior auricular fascia was still present.We took out the original frameworks,harvested cartilages again,fabricated the new frameworks and performed the classic one-time forming auricle reconstruction by Song;Group 1.2,14 ears(20.9%),the posterior auricular fascia was damaged,and the superficial temporal fascia was still present.We used the superficial temporal fascia flap to flip down and cover the back of the ear framework to replace the subcutaneous fascia flap behind the ear for auricle reconstruction;Category 2,33 ears(49.3%),the local hairless skin tissue of the reconstructed ear is insufficient.Group 2.1,17 ears(25.4%),local skin condition of reconstructed ear is good.The skin expander can be implanted at the same time with the original ear framework removed.The skin expander is removed in phase II,in which the newly carved auricle framework is implanted and the auricular reconstruction is performed;Group 2.2,16 ears(23.9%),local skin of reconstructed ear is shrinkage,ulceration,or scar formation.We removed the original ear framework and the necrotic tissue.After the local skin reaches appropriate conditions,we implanted the skin expander under the skin flap,and then performed auricular reconstruction with expansion method.Results:65 of 67 cases(97.0%)were rebuilt successfully and recovered well.In 1 case(1.5%)from group 1.2,after the operation,the flap at the helix had poor blood flow and delayed wound healing.The wound was healed after dressing change.In 1 case(1.5%)from group 2.2,three months after the operation,scar hyperplasia was found in the incision behind the ear.After 4 months of local injection of triamcinolone,the scar hyperplasia was improved and the reconstructed auricle was in good shape.All patients were followed up for 0.5 to 4 years,with an average of 2.8 years.The macroscopic structure of all the 67 reconstructed ears was stable and much better than before both in shape and structure.Conclusions:The failed reconstructed ears could be repaired by appropriate surgical method according to the local soft tissue condition.The shape of reconstructed ear was improved obviously and achieved good results.