Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections

Firmin, Françoise

doi:10.1080/02844319850158930

Cited by 226 publications

(136 citation statements)

References 5 publications

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“…Nagata 15 used a galeal flap to cover a cartilage wedge graft in stage 2. Among a subsequent series of 144 patients using the technique by Nagata, Firmin 16 reported 10 cases of partial failure of the graft and 1 total failure of the galeal flap. In 8 patients with microtia, Yoshimura et al 17 described a 2-stage method for reconstruction of congenital microtia using an anteriorly based mastoid fascial flap covered with a skin graft in the second operation.…”

Section: Discussionmentioning

confidence: 98%

Periosteal Flap Technique for Elevation of the Pinna in Microtia

Siegert

Ibrahiem

Magritz

2015

JAMA Facial Plast Surg

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he ear is a defining feature of the human face. It is considered one of the most important landmarks for a harmonious and aesthetically pleasing countenance. For any facial plastic surgeon, total auricular reconstruction is a formidable challenge because of the unique architectural topography of the ear. Any reconstructive surgical procedure aims for precise duplication of the missing portion. The ability of the facial plastic surgeon to reconstruct characteristics of the normal ear, including size, location, orientation, and anatomic landmarks, is important. If 1 or more of these features are missing, the ear will appear abnormal. 1 One of the goals of treatment of microtia is to create a well-defined postauricular sulcus.Many techniques for elevation of the pinna in cases of microtia have been described. These techniques range from simple elevation of the pinna using split-thickness skin grafts to transplanting cartilage and covering it with a temporal parietal fascia flap. This study presents our experience with a novel periosteal flap for elevation of the pinna in patients with microtia. Methods Report of Cases Case 1A 39-year-old man with right-sided grade III microtia and congenital auricular atresia had undergone more than 15 operations at other institutions for correction of the microtia and congenital auricular atresia (Figure 1). The result was unsatisfactory for the patient and his family, with multiple scars in the reconstructed auricle and the temple. Our surgical plan was to insert a tissue expander (350-mL crescentshaped implant; Mentor) under the skin of the previously IMPORTANCE For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts).OBSERVATIONS The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting. CONCLUSIONS AND RELEVANCEThe periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.

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Section: Discussionmentioning

confidence: 98%

Periosteal Flap Technique for Elevation of the Pinna in Microtia

Siegert

Ibrahiem

Magritz

2015

JAMA Facial Plast Surg

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“…The second stage is constructing the retroauricular sulcus, means the reconstructed ear is raised and an additional cartilaginous graft is used to increase the projection. Firmin of France follows Nagata's suggested new principle [11] that the type of microtia is defined by the appropriate incision for the lobular transposition and adaptation to the new framework by a Z plasty, transfixation incision or none of these in anotia. The new principle of Brent's technique [12] that reconstruction must start by placing the cartilagenouss framework on the ideal position under unscarred skin.…”

Section: Discussionmentioning

confidence: 99%

Auricular reconstruction — Our experience at marienhospital stuttgart, Germany

Fischer

Gubisch

Sinha

2010

Indian J Otolaryngol Head Neck Surg

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The aim of the paper is to report our experience of 60 ear reconstructions to correct the microtia with surgical technique. Autogenous rib cartilage was used to reconstruct the affected ear. Cartilage resorption was found in 10% of the cases, distortion and fusion of pinna in 20% of the cases and infection was found around 8% of the cases. Most of the patients were satisfied with the final result.

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“…Actualmente, la reconstrucción auricular con tejidos autólogos es la alternativa de elección para la corrección de esta patología. Las diversas técnicas de este tipo descritas en la literatura tienen en común la utilización de cartílago costal para la confección de un marco que dará forma y soporte a la oreja reconstruida (2)(3)(4)(5). Este marco cartilaginoso se compone de distintas piezas unidas entre si por medio de suturas con el fin de formar un esqueleto tridimensional que defina las estructuras anatómicas de una oreja normal.…”

Section: Introductionunclassified

“…Este marco cartilaginoso se compone de distintas piezas unidas entre si por medio de suturas con el fin de formar un esqueleto tridimensional que defina las estructuras anatómicas de una oreja normal. Dos de las tres principales técnicas de reconstrucción auricular proponen el uso de suturas metálicas de acero inoxidable con aguja doble armada para el montaje del marco (2,3). La principal ventaja de estas suturas está en facilitar la manipulación y el ensamblaje de las distintas piezas que componen el marco, debido a su configuración de agujas rectas en doble armada.…”

Section: Introductionunclassified

Sutura metálica con aguja doble armada para reconstrucción auricular: experiencia en su fabricación y uso

Erazo-Cortés¹,

Gutiérrez-Gómez²,

Mucharraz-Diaz³

2013

Cir. plást. iberolatinoam.

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ResumenLas técnicas de reconstrucción auricular que involucran tejidos autólogos utilizan suturas de acero inoxidable especialmente diseñadas para la construcción del marco cartilaginoso tridimensional que no están disponibles en nuestro país. En el presente trabajo describimos una técnica original para la confección de una sutura de estas características en base a materiales aprobados para uso médico y comparamos su resistencia antes y después de ser sometida a esterilización.Incluimos en el estudio 30 suturas confeccionadas según la técnica descrita y divididas en 3 grupos: sin esterilizar (control), esterilizadas por vapor y esterilizadas por gas (oxido de etileno). La fuerza de ruptura promedio del grupo control fue de 10 Newton, la del esterilizado por vapor fue de 24.1 Newton y la del esterilizado por gas fue de 23.9 Newton. El aumento en la resistencia de las suturas después de la esterilización fue estadísticamente significativo.Concluimos que es posible fabricar artesanalmente una sutura con características adecuadas para la reconstrucción auricular a un bajo costo y que actualmente es de uso habitual en nuestro Servicio para este tipo de procedimientos.Palabras clave Reconstrucción Auricular, Microtia, Sutura de acero inoxidable. Código numérico 2447-2545-14 AbstractAutologous tissue techniques for auricular reconstruction use specially design stainless steel sutures for the fabrication of the 3-D costal cartilage framework. These sutures are not available in our country. The present work describes an original handcraft technique for making this kind of sutures using medical approved components and compares their resistance with and without sterilization.Thirty sutures, made according to our technique, were included in this study divided in 3 groups: without sterilization (control), stem sterilization and gas sterilization (ethylene oxide). The average break force for the control group was 10 Newton, for the stem group was 24.1 Newton and for de gas group was 23.9 Newton. The suture resistance improved after the sterilization process with statistical significance.We conclude that is possible to make a steel suture for auricular reconstruction on a low cost per suture basis. These sutures are of choice in auricular reconstruction procedures at our institution. Key wordsAuricular Reconstruction, Microtia, Stainless steel suture. Numeral Code 2447-2545-14Erazo-Cortés, C.A.Sutura metálica con aguja doble armada para reconstrucción auricular. Experiencia en su fabricación y uso Double needle metallic suture for auricular reconstruction.Experience in Its fabrication and surgical use

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Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections

Cited by 226 publications

References 5 publications

Periosteal Flap Technique for Elevation of the Pinna in Microtia

Periosteal Flap Technique for Elevation of the Pinna in Microtia

Auricular reconstruction — Our experience at marienhospital stuttgart, Germany

Sutura metálica con aguja doble armada para reconstrucción auricular: experiencia en su fabricación y uso

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