Reconstruction of Microtia Using a Single Expanded Postauricular Flap without Skin Grafting: Experience of 683 Cases

Xing, Wenshan; Kang, Chunyu; Wang, Yue; Zhang, Qingguo

doi:10.1097/prs.0000000000004493

Cited by 33 publications

(42 citation statements)

References 18 publications

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“…Prior epidemiologic research into microtia has been predominantly focused on the condition itself, 1,45–47 with little published regarding the demographics of reconstruction specifically. Furthermore, the majority of outcomes research in this arena pertains to aesthetics, 2,23,35–40,53,54 thus creating a dearth of information on the overall safety of this operation. This study employed the ACS NSQIP-P database to provide an assessment of nationally reported demographic characteristics and postoperative complication rates of auricular reconstruction for microtia and anotia.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes

Cuccolo

Zwierstra²,

Ibrahim³

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Microtia refers to a congenital malformation of the external ear that is associated with a range of functional, psychosocial, aesthetic, and financial burdens. The aim of this study was to analyze the epidemiology and postoperative complication profile of microtia reconstruction. Methods: A retrospective review was conducted using data from the 2012–2017 the American College of Surgeons National Quality Improvement Program Pediatric databases. Patients with a diagnosis of microtia or anotia were identified using International Classification of Diseases codes. Demographics and postoperative complications were analyzed using Chi-square and t tests for categorical and continuous variables, respectively. Multivariable regression was performed to control for confounding variables. Results: A total of 466 cases were analyzed, of which 290 (62.2%) were performed by plastic surgeons and 176 (37.8%) by otolaryngologists (ear, nose, and throat physicians [ENT]). Autologous reconstruction was the predominant approach [76.2% of cases (n = 355)] in this cohort. ENT physicians operated on a significantly younger patient population (mean age 8.4 ± 3.2 years versus 10.0 ± 3.2 years, P < 0.001) and had higher rates of concurrent atresia/middle ear repair [21.0% (n = 37) versus 3.7% (n = 17)] compared with plastic surgeons. The rate of all-cause complications was 5.9% (n = 17) in the plastic surgery cohort and 4.0% (n = 7) in the ENT cohort ( P = 0.372). Multivariable regression did not reveal any statistically significant predictors for all-cause complications. Conclusions: Reconstruction of the external ear for patients with microtia/anotia is a safe procedure, with low rates of postoperative complications, readmissions, and reoperations. Autologous reconstruction remains the preferred modality for repair of the external ear and simultaneous atresiaplasty/middle ear repair does not increase the risk of complications.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes

Cuccolo

Zwierstra²,

Ibrahim³

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Under the condition of ensuring sufficient support, a better auriculocephalic sulcus can be achieved. Compared with other single expanded flap reconstruction methods 15,16 using residual ear cartilage to form the tragus, we select the remaining seventh cartilage, which forms the tragus with higher supportability and stronger structure to resistant the skin recession, and has more natural shapes.…”

Section: Discussionmentioning

confidence: 99%

A novel two-stage strategy combing tissue expansion and Nagata`s technique for total auricular reconstruction

Wang

Guo

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Although controversy around tissue expansion exists, a number of surgeons have successfully employed tissue expansion in the reconstruction of congenital microtia and traumatic auricular defects. In China, ear reconstruction surgeons reported thousands of microtia patients were reconstructed by skin expansion techniques (13,14,(19)(20)(21)(23)(24)(25)(26). Usually, the expanded flap is not large enough to drape the entire framework, so skin grafts and postauricular facial flap elevation are consequently inevitable.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, the expanded flap is not large enough to drape the entire framework, so skin grafts and postauricular facial flap elevation are consequently inevitable. Xing et al and Li et al described their novel strategies to avoid skin grafts; however, a surgical procedure with ≥3 stages was still required (19,26).…”

Section: Discussionmentioning

confidence: 99%

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Incision and flap design during total auricular reconstruction using a 2-stage strategy

Ou¹,

Cao²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Total auricular reconstruction is a challenge for plastic surgeons. Expanded flap method and Nagata's method with autologous costal cartilage are two leading techniques for ear reconstruction. And a two-stage strategy of expanded flap method received attention. In the present study, we report the incision and flap design of this strategy.Methods: In the first stage, an 80 mL kidney-shaped expander was inserted in the mastoid region with the larger pole superiorly. The expander pocket was dissected subcutaneously in the scalp area and subfascially in the lower third region. In the second stage, the expander was removed from a Y-shaped lobule incision on the remanent ear. Then the remnant ear was separated into three flaps: the posterior skin flap, anterior skin flap, and lobule flap. When the framework was fabricated, the base frame and the underlying pad, which enhanced the projection, were fixed together as a whole to provide a more prominent appearance. The framework was totally wrapped into the expanded single flap without free skin grafting. Lobule transposition and tragus construction were performed simultaneously instead of a third-stage surgery. The recipient bed of rotated lobule was resected only to the epidermal layer and the subcutaneous layer was preserved to avoid central necrosis.Results: A total of 21 patients received this strategy to reconstruct ear. With 3 months to 1.5 years of follow-up, 19 patients (90.5%) were satisfied with the reconstructed ears. 3 patients (14.3%) required further modification of reconstructed ear. No serious complications occurred during the procedures.Conclusions: With a Y-shaped incision, three-flap design of remanent ear and lobule rotation to an epidermal-removal area, tissue expander removal and modification of remanent ear can be performed effectively to avoid necrosis and an extra operation.

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Reconstruction of Microtia Using a Single Expanded Postauricular Flap without Skin Grafting: Experience of 683 Cases

Abstract: Therapeutic, IV.

Cited by 33 publications

References 18 publications

Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes

Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes

A novel two-stage strategy combing tissue expansion and Nagata`s technique for total auricular reconstruction

Incision and flap design during total auricular reconstruction using a 2-stage strategy

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