| Objectives:This study aims to assess the effect of the surgical reconstruction and the quality of life benefit following auricular reconstruction using autologous costal cartilage combined with retroauricular soft tissue expansion technique in children with congenital microtia.Methods:A retrospective study was conducted on 256 pediatric patients with congenital microtia who were admitted to the Department of Plastic Surgery of the Second Affiliated Hospital of Kunming Medical University from July 2013 to July 2020.The patients were followed up by telephone and informed to come to the hospital for review,recording the condition of the reconstructed ear and inquiring about the occurrence of complications.Two questionnaires were completed 6 months to 6 years after the third-stage auricle reconstruction with total expansion method.The first questionnaire evaluated the surgical effects of five aspects of auricle reconstruction:compared with the healthy side,the size,position and fidelity of the reconstructed ear(24 points);the angular size and stability of the reconstructed cranioauricular angle(12 points);the reconstruction of the auricle skin color and its coordination with the surrounding(10 points);the local scarring of the incision behind the ear(9 points);the appearance of the reconstructed ear subunit structure(45 points).The total score is 100 points and is divided into four levels according to the scoring results,namely excellent,good,fair,and poor.The second questionnaire is the Chinese version of Glasgow Children’s Benefit Inventory(GCBI),which is used to evaluate changes in health-related quality of life after surgery.A score of 0 indicates that there is no change in the quality of life related to health,+100 indicates the greatest improvement,and-100 indicates the greatest negative impact.And explore the relationship between the effect of ear reconstruction surgery and patients’ quality of life scores.Results:A total of 190 complete questionnaires were collected,including 126 male patients and 64 female patients,aged between 6 and 18 years old,with an average age of 13.27 years.Among 190 patients,47 cases(24.74%)had stage 1 complications:28 cases(14.74%)of dilator exposure,13 cases(6.84%)of infection,3 cases(1.58%)of hematoma,2 cases(1.05%)of dilator catheter rupture,1 case(0.53%)of incision dehiscence;45 cases(23.68%)Stage 2 complications occurred:20 cases(10.53%)of exposed steel wire,11 cases(5.78%)of cartilage stent exposure,8 cases(4.21%)of skin flap necrosis,5 cases(2.63%)of cartilage stent infection,and 1 case(0.53%)of scar hyperplasia behind the ear.The incidence of these complications did not affect the Chinese version of the GCBI scale and the overall surgical outcome score.According to the evaluation criteria of reconstructed ears,the score of the children was excellent in 69 cases(36.32%),good in 67 cases(35.26%),fair in 33 cases(17.37%),and poor in 21 cases(11.05%).Among the reconstructed ear subunit scores,the average score of the outer helix was the highest(4.66 points),and the average score of the tragus was the lowest(2.63 points).The final scores of the 190 Chinese version of the GCBI scale are all positive,indicating that the quality of life after surgery has been improved to varying degrees.Using One-way analysis of variance to make multiple comparisons of the scores of each dimension showed that the children had the most significant improvement in learning,followed by daily behavior.Pearson correlation analysis was used to evaluate the degree of correlation between the effect of reconstructive ear surgery and the total score of the Chinese version of GCBI,and the results showed a strong correlation(r=0.57,P<0.0001).Conclusions:Total skin expansion combined with autologous costal cartilage auricle reconstruction technique can achieve a high quality of external ear reconstruction and significantly improve the health-related quality of life.In addition,higher quality external ear reconstruction is significantly associated with higher health-related quality of life.This method has its unique advantages in the treatment of microtia in children.Correctly choose the best way to deal with the complications in time,which can obtain the best postoperative results. |
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