Modification of the cartilaginous framework for autologous ear reconstruction: Construction of a stable complete ring framework with grander highs and lows

Mazeed, Ahmed S.; O’Hara, Justine; Bulstrode, Neil

doi:10.1016/j.bjps.2020.11.042

Cited by 2 publications

(2 citation statements)

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“…Therefore, we believe that it is worthy information regarding the skin’s mechanical behavior and deformation properties during the suction process, which is critical for improving the clinical decision to decrease the focused stress and the rates of skin problems. Abundant research studies indicated that the stable support underneath the skin could disperse the region with high stress and thus decrease the risk of skin necrosis ( Wilkes et al, 2012 ; Tamura et al, 2014 ; Mazeed et al, 2021 ) but not reported in the auricular reconstruction field. Zhang et al proposed a novel concept of three-dimensional mechanical equilibrium cartilage scaffold, which could obtain a more stable structure by achieving lower rates of skin complications ( Zhang et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is feasible to develop an FE-based shape optimization to determine the mechanical behavior of the skin and the optimum auricular structure. Based on preceding studies, several efficacious approaches had been discovered that includes alteration of suture materials ( Sakamoto et al, 2012 ), stability of ear framework ( Mazeed et al, 2021 ), and decrease in the span using the drain to reduce skin stress and necrosis ( Bangun et al, 2010 ). However, these methods mainly relied on the clinical experiences of surgeons, which is a lack of related mechanical study to elucidate the relationship among the ear framework structure, suture, and skin necrosis.…”

Section: Introductionmentioning

confidence: 99%

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Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

Zhong

Chen

Zhao

et al. 2021

Front. Bioeng. Biotechnol.

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Skin necrosis is the most common complication in total auricular reconstruction, which is mainly induced by vascular compromise and local stress concentration of the overlying skin. Previous studies generally emphasized the increase in the skin flap blood supply, while few reports considered the mechanical factors. However, skin injury is inevitable due to uneasily altered loads generated by the intraoperative continuous negative suction and uneven cartilage framework structure. Herein, this study aims to attain the stable design protocol of the ear cartilage framework to decrease mechanical damage and the incidence of skin necrosis. Finite element analysis was initially utilized to simulate the reconstructive process while the shape optimization technique was then adopted to optimize the three-pretested shape of the hollows inside the scapha and fossa triangularis under negative suction pressure. Finally, the optimal results would be output automatically to meet clinical requirement. Guided by the results of FE-based shape optimization, the optimum framework with the smallest holes inside the scapha and fossa triangularis was derived. Subsequent finite element analysis results also demonstrated the displacement and stress of the post-optimized model were declined 64.9 and 40.1%, respectively. The following clinical study was performed to reveal that this new design reported lower rates of skin necrosis decrease to 5.08%, as well as the cartilage disclosure decreased sharply from 14.2 to 3.39% compared to the conventional method. Both the biomechanical analysis and the clinical study confirmed that the novel design framework could effectively reduce the rates of skin necrosis, which shows important clinical significance for protecting against skin necrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

Zhong

Chen

Zhao

et al. 2021

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

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“Mortise and Tenon Joint” Technique to Improve the Stability of Three-Dimensional Costal Cartilage Framework in Fully Expansion Ear Reconstruction

Yang,

Pan,

2024

Journal of Craniofacial Surgery

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Objective: For full expansion of ear reconstruction, the stability of a cartilage framework is very important. However, most techniques for framework fabrication focus on three-dimensional structure and adequate projection. Few studies are available on improving the stability of the reconstructed framework. This study introduces a new “mortise and tenon joint” technique to create a more stable framework in fully expansion ear reconstruction. Methods: A total of 137 patients with microtia underwent full expansion ear reconstruction with the “mortise and tenon joint” technique from January 2018 to July 2022. Results: Hematoma was found in 2 patients after the expander was implanted and evacuated timely to save the flap. Ear cartilage framework exposure occurred in 3 patients after the second stage of surgery. The wounds were debridement and covered by a retroauricular fascia flap with a skin graft. No other complications, such as infection, expander exposure, or rupture, were observed. All patients were followed up for 6 to 12 months after ear reconstruction and asked to fill in a form anonymously about their satisfaction with the reconstructed ear. One hundred thirty-four patients (97.8%) were satisfied with the results. Conclusions: In fully expansion ear reconstruction, the “mortise and tenon joint” technique improves not only the stability of the cartilage framework but also the stereoperception of the reconstructed ear. Most patients who underwent the new technique were satisfied with clear contour and delicate substructures of the reconstructed ear, matched skin color, and long-term dimensional stability.

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Modification of the cartilaginous framework for autologous ear reconstruction: Construction of a stable complete ring framework with grander highs and lows

Cited by 2 publications

References 28 publications

Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications

“Mortise and Tenon Joint” Technique to Improve the Stability of Three-Dimensional Costal Cartilage Framework in Fully Expansion Ear Reconstruction

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