Total Reconstruction of the Ear in Congenital Microtia

Spina, V; Kamakura, L; Psillakis, Jorge M.

doi:10.1097/00006534-197110000-00011

Cited by 32 publications

(8 citation statements)

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“…One early article mentioned the start of the serial ear reconstruction before 4 years old. 47 Most of the others start to perform the surgery at the age older than 7 years in average, 3,4,9,10,12,14,15,18,20,22,24,27,28,31,34–36,39–41,43,45,48–54 which is consistent with the US national survey published in 2013 1 and the international survey on the fourth International Ear Reconstruction Congress in Edinburgh. 55 …”

Section: Resultssupporting

confidence: 79%

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Complication Rate of Autologous Cartilage Microtia Reconstruction

Long

Huang

2013

Plastic and Reconstructive Surgery Global Open

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Background:Autologous cartilage has been widely accepted as the frame material of ear reconstruction for patients with microtia. Although rare, there are multiple complications related with the surgical reconstruction techniques. The authors performed a systematic review of the English literature of microtia reconstruction to determine significant surgical factors that are predictors of postoperative complications.Methods:A PubMed search using the terms “ear reconstruction” and “microtia” was conducted. Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, surgical techniques, the incidence of all kinds of complications, and the specific postoperative morbidity. Patient cohorts were pooled, and the incidence of complications was calculated. Significant predictors such as the use of tissue expander, simultaneously mid-ear reconstruction, with/without skin graft, and different fascia coverage were analyzed by chi-square test.Result:Of 320 articles found, 60 met the inclusion criteria. Totally 9415 patients with microtia were analyzed in this review with 1525 cases with complications. The overall complication incidence is 16.2% in average with a range of 0–72.9%. There was no significant difference when comparing the overall complication rate between with/without preexpansion 2-stage and multiple-stage techniques or with/without mid-ear reconstruction simultaneously.Conclusion:Although there is little agreement in literature regarding risk factors for complications, the authors were able to demonstrate several significant predictors by systematically analyzing 60 articles. Improved knowledge of the incidence of different complications related with various surgical methods can help surgeons provide improved preoperative counseling and take measures to minimize the risk.

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Section: Resultssupporting

confidence: 79%

“…Only 1 article published in 1971 reported a dead case due to the bronchopneumonia after cartilage harvest. 20 Table 2 listed out the overall incidence of different complications separately.…”

Section: Resultsmentioning

confidence: 99%

Complication Rate of Autologous Cartilage Microtia Reconstruction

Long

Huang

2013

Plastic and Reconstructive Surgery Global Open

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“…The disadvantage of this method is the need for an additional operative procedure to harvest material, though complications are very rare [2,3]. The frequently mentioned risk of material resorption seems to be very low [1].…”

Section: Introductionmentioning

confidence: 99%

Biocompatibility Testing of New Polymers in a Moving Implant Bed

Held¹,

Dost²,

Erdtmann³

et al. 2000

ORL

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Total reconstruction of the auricle requires a skilful surgical technique and an appropriate material for the shape-supporting frame. Up to now, there is no such material apart from autologous rib cartilage. The combination of chronic microtraumatisation of adjacent tissue caused by the mobility of an implant bed such as the auricle and the foreign-body reaction to currently available artificial polymers frequently results in extrusion. In our animal model (rats), polymers of different elasticity were implanted in a moving implant bed to analyse differences in foreign-body reaction related to implant elasticity. The results were significantly better for a rather stiff control material (porous polyethylene). A contributing factor may be better fixation of the implant material by tissue ingrowth into its micropores.

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“…In 1971, Spina et al shaped the antihelix by superimposing a Y-shaped piece over the base block. 2 They made the Y-shaped piece using the ninth costal cartilage. After their presentation, methods for using pieces of the sixth, seventh, or eighth costal cartilages to make antihelical prominence were proposed.…”

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confidence: 99%

Discussion

Park¹

2014

Plastic and Reconstructive Surgery

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1175L i et al.'s clinical results of microtia reconstruction using costal cartilage are excellent; shapes of the helical and antihelical components are especially impressive. The authors focused on making a natural shape of the antihelical framework in their study. They carved a groove into the base frame for attachment of a Y-shaped antihelical piece. It is noticeable that they shaved out the outer layer of the antihelical piece to make a smooth slope. Tanzer 1 was the first innovator and a great master in modern fabrication methods of total auricular reconstruction using autogenous costal cartilage. He shaped the antihelix on the base frame of the sixth and seventh synchondroses by indenting the scapha and triangular fossa. The method had been used up to the present in selective cases, when the opposite normal ear showed a less developed antihelix. However, it caused indecorous indentation of the synchondrosis portion in cases showing incomplete synchondrosis. In 1971, Spina et al. shaped the antihelix by superimposing a Y-shaped piece over the base block. 2 They made the Y-shaped piece using the ninth costal cartilage. After their presentation, methods for using pieces of the sixth, seventh, or eighth costal cartilages to make antihelical prominence were proposed. 3 The basic concept for making the ear framework by sculpturing the harvested costal cartilage pieces has been well established in recent literature. However, the technique should be modified in each microtia case, according to a variable shape of opposite normal ear and of the harvested costal cartilage. I believe that most experienced auricular surgeons have their own technical tips for smart fabrication in a variable condition of each case. To achieve antihelical shaping, we use one of four options (Fig. 1). We usually shape the antihelix and antitragus, and even the antitragal notch in one complex. First, when the ninth costal cartilage is long (>5 cm) and thick enough, the slender tip portion is used for shaping the intertragal notch, and the opposite thick extremity portion is used for both crura after longitudinal division, as in the method described by Spina et al. Second, if the cartilage is short and thin, the slender portion wrapped with perichondrium is used for shaping the inferior crura; the superior crura and components of the antitragus and the intertragal notch are made with pieces left over from fabrication of the other components. Third, when the eighth cartilage is thick and broad enough, a shorter extra piece left over after use in the helical component is used for shaping the antihelix and antitragus. As a fourth option, extra pieces of sixth and seventh costal cartilage are used for shaping the antihelix and antitragus complex.During framework fabrication, we should keep in mind that intemperate shaving and carving out of the costal cartilage might cause unwanted distortion of the assembled framework. The sculpturing technique should aim to reduce the effect of warping 4 and minimize later absorption of the cartilage. The degre...

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Total Reconstruction of the Ear in Congenital Microtia

Cited by 32 publications

References 0 publications

Complication Rate of Autologous Cartilage Microtia Reconstruction

Complication Rate of Autologous Cartilage Microtia Reconstruction

Biocompatibility Testing of New Polymers in a Moving Implant Bed

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