“…After screening, 14 articles were included in this meta-analysis. 6-19 The literature screening process was shown in Figure 1. The characteristics of the included literature were shown in Table 2.Figure 1.PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Both the auricle reconstruction with expanded flaps and the auricle reconstruction with non-expanded flaps have advantages and disadvantages. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The auricle reconstruction with expanded flaps is generally not affected by the degree of ear malformation and is suitable for most patients with microtia. Moreover, the expanded flaps have more blood circulation and are easier to survive.…”
Objective We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 2.5% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 1.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 2.4% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis ( P > .05). Conclusion The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.
“…After screening, 14 articles were included in this meta-analysis. 6-19 The literature screening process was shown in Figure 1. The characteristics of the included literature were shown in Table 2.Figure 1.PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Both the auricle reconstruction with expanded flaps and the auricle reconstruction with non-expanded flaps have advantages and disadvantages. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The auricle reconstruction with expanded flaps is generally not affected by the degree of ear malformation and is suitable for most patients with microtia. Moreover, the expanded flaps have more blood circulation and are easier to survive.…”
Objective We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 2.5% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 1.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 2.4% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis ( P > .05). Conclusion The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.
“…Studies that evaluated individual substructures revealed the helix and lobule fulfill patient's expectations, but the tragus and antitragus require improvement. [16][17][18][19][20] Choi et al stated the primary focus should be the larger contouring, location, and degree of projection, rather than more detailed factors. 15 In contrast, these findings indicate that enhanced definition of the lower auricular units could potentially lead to an increase in patient satisfaction.…”
Importance: In a patient-centered field such as plastic surgery, patient-reported satisfaction can measure the success and value of surgery, since it is not uncommon for patient and surgeon assessments to differ. Currently, there is no standard for evaluating patient-reported satisfaction postauricular reconstruction. Objective: To systematically review the literature regarding patient-reported satisfaction postauricular reconstruction in microtia patients. Evidence Review: The databases MEDLINE, EMBASE, Cochrane, and Scopus were searched and preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Studies documenting patient-reported satisfaction postauricular reconstruction in microtia patients were included. All techniques for ear reconstruction have been included in this review. Findings: Nineteen studies utilizing autologous reconstruction technique, comprising 3694 patients, met inclusion criteria. No standardized patient satisfaction assessment was used throughout the studies, indicating criteria variability to measure outcomes. Auricular substructure analysis highlighted lower patient satisfaction with the tragus and antitragus compared with the upper units. In addition, satisfaction depended on patient perception, not on a low surgical complication rate. Conclusions: There is a clear need to incorporate a standardized validated surgery-specific questionnaire related to patient satisfaction in the auricular reconstruction protocol.
“…Continuous studies had reported various aspects for providing an adequate blood supply of the skin flap, but few reports have focused on the mechanical factors. During the first surgical phase, it is necessary to place drains with a negative suction vacuum pressure of 0.01 Mpa ( Sasaki et al, 2021 ) between the skin envelop and underlying cartilage for 3–7 days ( Bonilla, 2018 ), which for obtaining a hermetic closure of the tissues to achieve adequate adhesion of the tissue with a better ear form ( Torres et al, 2021 ). However, the sustaining suction would create a negative press at the inner surface of the skin flap, which produces the passive stretch tension inside the skin.…”
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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