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This was a retrospective study examining the psychosocial morbidity of patients before and after ear reconstruction. Semistructured questionnaires were sent to 90 patents with significant congenital or acquired auricular deformity 2.2 years (range 3 months to 5 years) following autogenous or osteointegrated reconstruction. Sixty-two patients (69%) responded. Twenty-two of the patients below 12 years, who had undergone reconstructive surgery, also completed the Childhood Experience Questionnaire. These were compared with a cohort of 362 normal patients. There was significant psychosocial morbidity in both children and adults with auricular deformity. Seventy-one percent of patients reported reduced self-confidence that affected both social life and leisure activity. Teasing was a prominent symptom in both children (88%) and adults (85%) but was a motivational factor for surgery in children only. Dissatisfaction with the appearance (73.1%), on the other hand, was the main reason for treatment in adults. Following ear reconstruction, 74% of adults and 91% of children reported an improvement in self-confidence resulting in enhanced social life and leisure activities in both adults and children. There was no difference between osteointegrated and autogenous reconstruction. Sixty percent of patients reported their result as excellent. The patients scored their result better than the surgeon. We conclude that auricular reconstruction has significant psychosocial benefit in the majority of children and adults despite donor-site morbidity and a range of technical result.

Transforming growth factor beta1 (TGFbeta1) is a multifunctional cytokine known to be involved in a number of human diseases. It is believed to play an important role in wound healing and repair, as it is a key regulator of the production and remodelling of the extracellular matrix through its effect on mesenchymal cells. Over the last few years, it has become evident that the signalling pathway of TGFbeta is complex with numerous receptor-ligand interactions, intracellular pathways and a number of mechanisms, which not only control the signalling but may also decide the response to the TGFbeta signal. This review focuses on TGFbeta1 signalling and the role that TGFbeta1 plays in wound healing, repair and scarring.

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