Thermosensitivity in a reconstructed microtic ear

The aim of this study was to evaluate thermo-thresholds in autologous reconstructed microtic ears. Nineteen patients with unilateral microtia were investigated no less than two years after the last operation (3.6+/-1.7 years). Their normal corresponding ear acted as controls. Eight healthy children were also investigated to illustrate technical differences between measuring the two sides. Thermal sensitivity was tested quantitatively using a SENSELab MSA Thermotest. The skin temperature was also tested. Three different areas of the ear were examined: the lobe, the antihelix, and the helix. The reconstructed ear had a significantly higher skin temperature for all investigated areas compared with the normal ear (reconstructed ear 30.2+/-1.2 degrees C, normal ear 28.6+/-0.9 degrees C). For the controls there were no significant differences in any area. For the patients there were small differences in perception of cold between the reconstructed and the normal ear. There were significant differences in the antihelix region and the helix in heat perception in the reconstructed ear compared with the normal one (helix reconstructed ear 43.9+/-3.8 degrees C, helix normal ear 38.3+/-3.0 degrees C, antihelix reconstructed ear 39.9+/-3.0 degrees C, antihelix normal ear 36.4+/-1.7 degrees C). The reconstructed ear had a changed thermosensitivity, but there did not seem to be any clinical disadvantages.     

Reconstruction of the microtic external ear in adults using porous polyethylene implant

Autogenous rib cartilage and many other materials have been used for external ear reconstruction. Although the most commonly used material is the former, harvesting, carving and shaping are problems. Recently, porous polyethylene implants have proved to be useful for ear reconstruction. Ten ear reconstructions were performed in adults using porous polyethylene implants over the last two years. The patients were treated in two stages. First, the material was implanted and at the second stage the ear was elevated and the lobule was transposed. Both stages were performed under local anesthesia. There were three exposures which were managed without implant removal. One infected implant was salvaged by irrigation with antibiotics. All reconstructions were accepted as pleasing by the patients.Presented at the 17th National Congress of the Turkish Society of Plastic Surgeons, Northern Cyprus, 1995     

Reconstruction of the microtic ear

Although microtia occurs in only 1:7000 to 8000 births, this major congenital ear deformity can result in significant psychological trauma for the affected child. Reconstruction of this complex deformity represents one of the greatest challenges to the reconstructive surgeon. Based on the pioneering work of Tanzer and Brent, the techniques have matured to the point that consistently good results can be obtained and many of the resultant problems associated with the deformity avoided. In classic microtia, a sausage-shaped vestige is made up of a rudimentary lobule and various additional remnants. The external canal is usually absent. Where hearing is normal in the opposite ear, it is not necessary to reconstruct the middle ear or external canal on the affected side, and these procedures may compromise the result of the external ear reconstruction. The staged reconstruction of the microtic ear, which can begin at 5 years of age, involves: placement of an autogenous cartilage framework; rotation of the lobule, formation of a conchal depression and tragal reconstruction; limited elevation of the helical rim; and minor final adjustments. The cartilage is placed during the first stage to make maximal use of the non-scarred elastic skin in the area of the skin pocket. This allows better splicing of the lobule in the second stage. The use of a very thin skin flap over the framework allows heightened definition of cartilage detail, better skin-cartilage coaptation, and at appears to play a vital role in preventing late deformation of the cartilage framework.(ABSTRACT TRUNCATED AT 250 WORDS)     

皮肤定量扩张法在耳廓再造中的应用及并发症的处理

目的 探讨皮肤扩张器的定量扩张法在在耳廓再造中的应用,并对所发生的并发症进行处理.方法 选择50 ml肾形扩张器埋置于残耳后乳突区无毛发皮下,术后3 d拔除引流管,10d拆除缝线.术后7 d进行常规注水,每周3次,每次注水约5 ml,注水总量为60 ml左右.注水完毕后维持扩张1个月.结果 1992年1月至2006年12月共收治先天性小耳畸形患者5 248例,完成50ml肾形扩张器埋置6 252只.扩张器维持扩张完毕后可见扩张皮肤质薄、血管丰富.并发症有血肿、扩张器外露、创口裂开、感染等,发生率较低,约为7.79%.结论 皮肤定量扩张法操作简单、并发症较少,为耳廓再造提供了良好的无毛发、质薄、血供丰富可靠的皮肤.     

自体肋软骨多层拼接雕刻耳支架在小耳畸形耳廓成形术中的应用

目的 探索利用自体肋软骨多层拼接雕刻耳支架进行小耳畸形耳廓成形术的临床效果.方法 自2010年2月至2011年5月,对29例单侧小耳畸形患者进行自体肋软骨4层拼接雕刻耳支架耳廓成形术.结果 29例形成的外耳横突高度均一次性达到2 cm,基本与对侧外耳横突高度一致,患者及其家属均满意.随访3～12个月,仅1例再造外耳横突高度明显降低,经寻问患者,因睡觉姿势未注意保护患侧再造外耳,导致形成的外耳经常受压所致.结论 自体肋软骨多层拼接雕刻耳支架耳廓形成术临床效果好,可以使成形的外耳横实达到正常高度,从而避免在Ⅲ期手术时再次肋软骨移植以增加横突高度.     

耳垂型小耳畸形再造耳廓的细节性修整

目的:探讨耳垂型小耳畸形再造耳廓的细节性修整方法。方法:再造耳廓的细节性修整包括耳屏成形、耳轮脚构建和耳甲腔加深;如果需要进行再造耳廓和对侧正常耳廓高度的对称性调整,则进行残耳软骨筋膜瓣的肋软骨支架下的牢固填充。结果:2004年1月～2008年12月共完成耳垂型小耳畸形耳廓再造细节性修整1427只,其中应用残耳软骨筋膜瓣行再造耳廓高度增加396只。157例患者随访1～3年,耳屏、耳轮脚结构形态逼真、残耳软骨能牢固支撑肋软骨支架,耳廓立体感强。结论:耳垂型小耳畸形再造耳廓细节性修整方法简单、操作方便,再造耳廓形态自然、对称性良好。     

An analysis of quantitative measurements of drainage exudate using negative suction in 96 microtia ear reconstructions

Negative suction drainage is commonly used for the prevention of seromas or hematomas in auricular reconstruction surgery; however, there are few reports regarding the quantitative measurement of negative suction and its relation to disposed time, patient age or microtia type. In the present study, the authors recorded the volume of suction exudate in microtia reconstruction and elaborate on the relevant details of controlling negative suction. A negative suction drainage system was applied in 96 microtia patients between 2007 and 2010. Two small polyethylene drains were inserted adjacent to the concha and the scapha, respectively. The volume of exudate was recorded for three days after surgery and was analyzed according to disposed time, patient age and microtia type. The drains were removed on the third postoperative day, when only a small amount of exudate remained. A significant change in drainage was observed over three days postoperatively, and the quantity decreased progressively on the third postoperative day. Comparison of age groups showed that the volume of drainage from adults was greater than that from children or adolescents in the first two postoperative days, regardless of whether the drains were inserted in the scapha or concha. No statistical differences were found on the third postoperative day. A comparison of drain types revealed no statistically significant differences between scapha and concha drains three days postoperatively. The analysis demonstrated that drainage quantity is related to disposed time and patient age, but not to microtia type. The authors recommend removal of suction drains on the third postoperative day. Moreover, individualized negative suction treatment according to age or microtia type provides a safe and consistent approach to achieving acceptable results and fewer complications.     

经残耳切口双平面埋置大容量扩张器行全耳再造术

目的 探讨经残耳切口双平面埋置大容量扩张器行全耳再造术的方法,以及优缺点和可行性.方法 对52例小耳畸形患者,一期采用经残耳切口,于耳后无发区浅筋膜深面及有发区浅筋膜浅层双平面埋置大容量扩张器(150 ml),二期行自体肋软骨支架、无需植皮的全扩张法全耳再造术,同时与采用耳后乳突区浅筋膜表面埋置大容量扩张器的32例患者做对照.通过对2组患者二期再造前扩张器下移的距离、三期颅耳沟外形及并发症的发生率等的分析比较,评价该手术的效果.结果 双平面组术后扩张器下移距离为(0.7 ±0.3)cm,明显小于对照组的(1.3±0.4) cm,且差异有统计学意义(P＜0.05).二期术后6～12个月,双平面组5例颅耳沟浅显,而对照组颅耳沟浅显12例,均经颅耳沟切开松解植皮后与对侧基本对称.结论 该方法可明显减少大容量扩张器下移的距离,使得上部皮肤得到充分的扩张,再造耳上部颅耳沟外观更佳.     

Importance of ear reconstruction for the aesthetic balance of the facial contour

The author treated 146 cases of congenital external ear deformities, proposing their classification into four groups: anotia, microtia, macrotia, and prominent ears. The importance of a normal appearing ear in the overall facial harmony and contour is emphasized and reconstructive techniques to accomplish this are described.     

先天性小耳外中耳畸形断面影像解剖学分析

目的 通过对先天性小耳患者外、中耳的畸形断面影像解剖学特征的系统研究,比较其与正常解剖之间的差异,总结重要解剖结构的变异规律及相互关系,以利于临床分型及手术治疗.方法 选取2009年6月至12月中国医学科学院整形外科医院外耳整形中心住院诊断为小耳畸形的36例患者,采用自身对照研究.研究组50只耳,其中单侧畸形22例22只,双侧畸形14例28只;对照组为单侧畸形之健侧耳22例22只.行螺旋CT颞骨高分辨扫描,应用Mimics软件,生成冠状位、矢状位图像及三维重建图像,进行距离和角度的测量.结果 小耳畸形患者以Max分型,鼓室前后径Ⅰ、Ⅱ、Ⅲ型分别为(7.75±1.92)mm、(6.17±2.56)mm、(6.31±3.40)mm(F=5.777,P=0.001);鼓室上下径Ⅰ、Ⅱ、Ⅲ型分别为(14.66±4.75)mm、(14.35±5.12)mm、(9.97±4.36)mm(F=6.601,P=0.001);3型小耳畸形乳突气化程度分别为硬化型13.33%、13.64%、30.77%,板障型13.33%、18.18%、7.69%,混合型0、9.09%、38.46%,气化型73.33%、59.09%、23.08%(x2=24.11,P=0.002);面神经遮盖前庭窗的发生率分别为21.43%、47.62%、54.55%(x2=23.44,P=0.002).研究组与对照组间差异有统计学意义.结论 小耳畸形根据Max分型,具有随耳廓畸形程度增加,中耳畸形程度亦增加的趋势,其中Ⅱ型小耳的解剖结构变异复杂,可进行亚分型.

Abstract：

Objective To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery. Methods From Jun. to Dec. 2009,36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured. Results The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7. 75 ± 1. 92) mm and ( 14. 66 ± 4. 75 ) mm for type Ⅰ ; (6.17±2.56) mm and(14. 35 ±5. 12) mm for type Ⅱ ; (6. 31 ±3. 40) mm and (9.97 ±4.36) mm for type Ⅲ ( P = 0.001). The mastoid pneumatization degree for type Ⅰ , Ⅱ , Ⅲ were 13.33% , 13.64% ,30.77% in sclerotic type, 13. 33% , 18. 18 % , 7. 69% in diploetic type, 0, 9. 09% , 38. 46% in composite type,73. 33% ,59. 09% ,23. 08% in pneumatic type(x2 = 24. 11 ,P = 0. 002 ). The cover of fenestra vestibuli by facial nerve was 21. 43% ,47.62%, 54.55% (x2 =23.44, P = 0. 002 ) for type Ⅰ , Ⅱ , Ⅲ. There was a statistical difference between the microtia group and the control group. Conclusions According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type Ⅱ microtia, which should be sub-classified.     

耳郭再造的再认识

耳郭再造技术的细节较多且难以把控,往往不易获得稳定效果。经过60余年的发展,该技术有了显著提高,Nagata二次法、部分扩张皮瓣法、完全扩张皮瓣法均得到了广泛应用。而获得再造耳满意效果和高优良率的前提是能够认识和理解每种再造方法,并根据患者的实际条件及每种耳郭再造技术的优势和不足,建立个性化治疗方案,有利于提高耳郭再造的整体效果和优良率。同时,也应对耳郭再造的整形医师进行系统规范培训,从而整体提高我国耳郭再造的技术水平。     

小耳畸形残耳软骨的生物化学研究

目的　探讨正常耳软骨与先天性小耳畸形的残耳软骨生化成分的异同 ,进而推论小耳畸形的病因。方法　选取年龄在 10岁左右 ,Tanzer分类ⅡA型的 7例先天性小耳畸形患者的残耳软骨 (A组 )。同时取 7名同龄尸体的正常耳廓耳甲部分的软骨 (B组 )。各取 7份标本做生化检查 ,测定胶原、糖胺多糖 (glycoaminoglycan ,GAG)含量 ;硫酸软骨素 (chondroitinsulfate,Chs)、硫酸角质素 (keratansulfate ,KS)和透明质酸 (hyaluronan ,HA)各占GAG的百分含量。结果　A组与B组之间胶原含量差异无显著性意义 ;GAG含量差异有显著性意义A组 (49.0 0± 2 5 .6 0 ) μg/mg比B组 (2 8.2 5± 4 .80 ) μg/mg多。在GAG中的组成部分中 ,A组HA(38.96± 4 .97) %、Chs(2 9.0 2± 4 .12 ) %、KS(32 .16± 7.4l) %与B组HA(32 .94± 3.2 4 ) %、Chs(33.10± 2 .6 1) %、KS(33.96± 1.6 6 ) %之间HA和Chs含量差异有显著性意义 ,而KS含量差异无显著性意义。结论　残耳软骨与正常耳软骨中胶原含量无差异 ,但含GAG前者比后者多。在GAG中的各成分的百分含量中 ,残耳软骨含HA较高 ,Chs较低 ,KS与正常耳软骨无差异。     

耳甲腔型小耳畸形的耳廓再造术

目的 分析和探讨适合耳甲腔型小耳畸形的耳廓再造术.方法 采用自体肋软骨二期法耳廓再造术对13例(14只耳)耳甲腔型小耳畸形患者实施耳廓再造,一期为肋软骨耳廓支架的成型和移植,二期为颅耳角成形.结果 经过2个月至2年的随访,14只再造耳外形满意,耳解剖结构清晰,并拥有良好的颅耳角,其大小、位置与健侧耳也基本一致.结论 自体肋软骨二期法耳廓再造术是矫正耳甲腔型小耳畸形较理想的手术方法.

Abstract：

Objective To investigate the method of auricular reconstruction for concha-type microtia. Methods Two-staged auricular reconstruction was applied in 13 cases (14 ears) with conchatype microtia. The cartilage auricular framework was fabricated and implanted in the first stage, followed by ear elevation and cranio-auricle angle formation at the second stage. Results The patients were followed up for 2 months to 2 years with satisfactory aesthetic result. The reconstructed ears had a good appearance and position, and were symmetric to the healthy ears. Conclusions The two-staged auricular reconstruction with autologous cartilage framework is ideal for concha-type microtia.     

残耳软骨细胞种植于聚羟基丁酸酯-聚羟基己酸酯共聚物形成组织工程软骨

目的探讨以聚羟基丁酸酯-聚羟基己酸酯(PHB-PHH)共聚物为细胞外支架、以残耳软骨作为种子细胞形成组织工程软骨的可能性。方法取先天性小耳畸形8例患者的残耳软骨，以胶原酶消化后种植于PHBPHH支架，体外培养1周后种植于8只裸鼠一侧背部皮下为实验组，另一侧只植入支架材料作为对照组。于4周、8周后取出标本，做大体观察及HE染色、Masson三色染色检查。结果4周时实验组镜下显示有新生软骨形成，但仍有部分支架材料残留；8周时实验组标本大体观察及HE染色、Masson三色染色检查新生软骨与人耳软骨相似，支架材料已完全吸收。对照组无软骨形成。结论以残耳软骨作为种子细胞，以PHB-PHH共聚物为细胞外支架可以形成组织工程软骨，新生软骨大体观察、组织学检查与人耳软骨相似。     

Retention of a reconstructed nipple using a C-V flap with different layer thicknesses in the C-flap

Background: The C-V flap for nipple reconstruction is now one of standard surgical techniques. But decreased projection is still a problem. In recent years, it has been suggested that projection can be more easily maintained when raising of the C-flap is performed with a split thickness dermis. In this study, we examined whether decrease of projection can be prevented by raising of a C-flap with a split dermis rather than with full dermis.

Methods: A total of 49 consecutive patients who underwent reconstruction of a nipple using the C-V flap technique were enrolled. The patients included 22 who underwent surgery using a C-flap with a full thickness dermis (Group F), and 27 who underwent surgery with raising of a flap with a split thickness dermis (Group S). The size of the reconstructed nipple was measured at 2?weeks, 6?months and 1?year postoperatively for comparison between Groups F and S.

Results: Partial necrosis of the C-flap end occurred in 4 subjects in only Group S. The decrease in projection after 1?year postoperatively in Group S was significantly lower than that in Group F. In contrast, the teat base size in Group F tended to be greater than that in Group S, suggesting a tendency for an expanded base using a flap with a full dermis.

Conclusions: Our results indicated that it is recommended to use a C-flap with a split dermis for cases with high projection of the nipple on the contralateral side.