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Yamada A, Chwa ES, Boctor MJ. Update on Total Auricular Construction. Plast Reconstr Surg 2024; 153:1011e-1021e. [PMID: 38657012 DOI: 10.1097/prs.0000000000011219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management. SUMMARY Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors' focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.
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Affiliation(s)
- Akira Yamada
- From the Division of Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital
- Northwestern University Feinberg School of Medicine
| | - Emily S Chwa
- Northwestern University Feinberg School of Medicine
| | - Michael J Boctor
- Northwestern University Feinberg School of Medicine
- Department of Plastic Surgery, Loma Linda University Health
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2
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Abukhder M, Tarassoli S, Hassan R, Onions E, Nasri Elmi S, Whelan R. Exploring Aesthetic Outcomes and Complications in Auricular Reconstruction Utilising Autologous Cartilage: A Systematic Review and Narrative Synthesis. Cureus 2024; 16:e56345. [PMID: 38633940 PMCID: PMC11021216 DOI: 10.7759/cureus.56345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand.
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Affiliation(s)
- Munir Abukhder
- Oral and Maxillofacial Surgery, Northwick Park Hospital, London, GBR
| | | | - Ridwanul Hassan
- Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham (QEHB), Birmingham, GBR
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3
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Fu Y, He A, Xie Y, Zhu Y, Li C, Zhang T. The Effect of Fixation Materials on the Long-Term Stability of Cartilage Framework for Microtia Reconstruction. Facial Plast Surg Aesthet Med 2023; 25:126-131. [PMID: 36520597 DOI: 10.1089/fpsam.2022.0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To observe the effect of fixation materials on the long-term stability of the cartilage framework in auricular reconstruction. Methods: Consecutive patients who underwent the first stage of auricular reconstruction by the same surgical team from September 2018 to March 2021 were included. Those with braided absorbable suture, polypropylene suture, and titanium wire were defined as Groups A, B, and C, respectively. Six months later, when the patients underwent the second stage of surgery, absorption and deformation of the framework were assessed. Results: A total of 604 patients (622 ears) were included. The most common occurrence was spot absorption in the antihelix and was observed in 34.7%, 17.4%, and 22.8% ears in the A, B, and C groups, respectively (p < 0.05). There were also significant differences regarding severe absorption and severe deformation. The histological examination suggested that those in Group A had more T cells and macrophages around the suture than those in Groups B and C. Conclusion: Absorbable suture seems to correlate with higher risk of cartilage absorption and helix displacement. Titanium wire had the lowest rate of helix pop-out or fracture, which means the best stability.
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Affiliation(s)
- Yaoyao Fu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Aijuan He
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Youzhou Xie
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yaying Zhu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chenlong Li
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
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4
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Zhong J, Chen S, Zhao Y, Yin J, Wang Y, Gong H, Zhang X, Wang J, Wu Y, Huang W. Shape Optimization of Costal Cartilage Framework Fabrication Based on Finite Element Analysis for Reducing Incidence of Auricular Reconstruction Complications. Front Bioeng Biotechnol 2021; 9:766599. [PMID: 34966727 PMCID: PMC8711272 DOI: 10.3389/fbioe.2021.766599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Jing Zhong
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Suijun Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanyan Zhao
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Junfeiyang Yin
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yilin Wang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Haihuan Gong
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xueyuan Zhang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiejie Wang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yaobin Wu
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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5
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Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3213-3234. [PMID: 34489212 DOI: 10.1016/j.bjps.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Auricular reconstruction for microtia is most frequently performed using autologous costal cartilage (ACC) or porous polyethylene (PPE) implants. Short-term results are generally promising, but long-term results remain unclear. Long-term outcomes were explored in this systematic review, and minimal reporting criteria were suggested for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included if postsurgical follow-up was at least 1 year. Outcome reporting was split into separate publications, and results on complications were reported previously. This publication focused on long-term aesthetic, patient-reported, and sensitivity outcomes. RESULTS Forty-one publications reported on these outcomes. Both materials led to aesthetically pleasing results and high rates of patient satisfaction. ACC frameworks grew similarly to contralateral ears, and the anterior surface of auricles regained sensitivity. Furthermore, postoperative health-related quality of life (HRQoL) outcomes were generally good. Data synthesis was limited due to considerable variability between studies and poor study quality. No conclusions could be drawn on the superiority of either method due to the lack of comparative analyses. CONCLUSION Future studies should minimally report (1) surgical efficacy measured using the tool provided in the UK Care Standards for the Management of Patients with Microtia and Atresia; (2) complications including framework extrusion or exposure, graft loss, framework resorption, wire exposure and scalp/auricular scar complications and (3) HRQoL before and after treatment using the EAR-Q patient-reported outcome measure (PROM).
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Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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6
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Ronde EM, Esposito M, Lin Y, van Etten-Jamaludin FS, Bulstrode NW, Breugem CC. Long-term complications of microtia reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:3235-3250. [PMID: 34481742 DOI: 10.1016/j.bjps.2021.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Microtia is a rare disorder characterized by malformation or even complete absence of the auricle. Reconstruction is often performed using autologous costal cartilage (ACC) or porous polyethylene implants (PPE). However, the long-term outcomes of both methods are unclear. OBJECTIVE This systematic review aimed to analyze long-term complications and suggest minimal reporting criteria for future original data studies. METHODS A systematic literature search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included provided that the follow-up period was at least one year. This publication focused on long-term complications reported in patients with a postoperative follow-up period of at least one year. RESULTS Twenty-nine publications reported on complications during long-term follow-up. Overall long-term complication rates were not reported. The incidence of individual complications during long-term follow-up was less than 10% after ACC reconstruction and less than 15% in PPE reconstruction. Framework resorption and wire exposure were reported even after an extended follow-up of more than five years after ACC reconstruction, while reports on the extended long-term results of PPE reconstruction are limited. Data synthesis was limited due to heterogeneity and poor study quality. CONCLUSIONS Future studies should report on long-term complications including framework exposure or extrusion, graft loss, framework resorption, wire exposure and scalp and auricular scar complications. We recommend a surgical follow-up of at least five years.
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Affiliation(s)
- E M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - M Esposito
- Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Y Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China
| | - F S van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - N W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - C C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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7
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The Effect of Absorbable and Non-Absorbable Sutures on Nasal Width Following Cinch Sutures in Orthognathic Surgery. Symmetry (Basel) 2021. [DOI: 10.3390/sym13081495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Non-absorbable materials (nylon) are always used in cinch sutures to maintain nasal width and to improve harmonious facial symmetry in orthognathic surgery. However, a few drawbacks of nylon materials have been clinically reported following orthognathic surgery, such as nasal irritation and exposure of the sutures. An absorbable material (PDS) has been proposed in cinch sutures, not only to avoid the complications of nylon but also to stabilize the nasal width for a long-term follow-up. Methods: Fifty-seven patients with Angle’s malocclusion classification III receiving orthognathic surgery were enrolled in this study. A non-absorbable material (nylon) and an absorbable material (PDS) were utilized for the cinch sutures. Pre-operative (T1) and post-operative six-month (T2) craniofacial 3D images were collected for all patients to measure the alar curvature (Ac) width and the alar base (Al) width. A significance level of p < 0.05 was applied in the statistical analysis. Results: With the approval of IRB, cinch suturing was performed with nylon in 29 patients and with PDS in 28 patients. Pre-operative Ac and Al distances showed no significant difference between these two groups. There were also no significant differences between the suture materials in the peri-operative change in nasal width, including Ac (nylon: 1.999 ± 1.40; PDS: 1.484 ± 0.97; p = 0.112) and Al (nylon: 1.861 ± 1.66; PDS: 1.115 ± 0.92; p = 0.056). Conclusions: For cinch sutures in orthognathic surgery, PDS can maintain the peri-operative nasal width similarly to nylon; additionally, it can be absorbed in a timely manner without the drawbacks of non-absorbable materials.
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Reitz C, England C, Johnson ON. Cartilage Framework Fixation with 2-Octyl Cyanoacrylate in a Prelaminated Radial Forearm Free Flap Total Auricular Reconstruction. Cureus 2019; 11:e6389. [PMID: 31938666 PMCID: PMC6957031 DOI: 10.7759/cureus.6389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Autologous total auricular reconstruction requires an intricately sculpted, curved, and stacked cartilaginous framework implanted under healthy vascularized tissue. The ideal fixation technique would be readily available, easy to deploy, and free of complications. Commonly used sutures can fracture fragile pieces, inadequately maintain shape, or migrate. Steel wire can erode through soft tissues, extrude, fracture, or become infected. We successfully used 2-octyl cyanoacrylate alone to fixate an autologous costal cartilage framework designed for a total auricular reconstruction in an adult trauma patient. We had no sutures or wires in the final construct. The key aspects of our technique included the following: use of small aliquots, application only at cartilage-to-cartilage interfaces, use of temporary shaping (needles and lasso sutures), and avoidance of excess spillage of adhesive on any portion that would directly contact soft tissue. The framework was implanted into a prelaminated radial forearm free flap, which was then transferred to the head and neck region at a second stage. At two-year follow-up, the framework held satisfactory shape without any complications such as resorption, exposure, or infection.
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Affiliation(s)
- Cara Reitz
- Surgery, William Beaumont Army Medical Center, El Paso, USA
| | - Chris England
- Otolaryngology, Proliance Surgeons, Mount Vernon, USA
| | - Owen N Johnson
- Surgery, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, USA
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Sakamoto A, Rikimaru H, Rikimaru-Nishi Y, Watanabe K, Hashiguchi S, Kanazawa T, Nakamura KI, Kiyokawa K. Experimental study on maintaining the curvature of transplanted cartilage: Influence of the number of cartilage struts. J Plast Reconstr Aesthet Surg 2019; 72:1340-1346. [PMID: 31064705 DOI: 10.1016/j.bjps.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND When auriculoplasty is performed for microtia, wire often becomes exposed during the long postoperative period. We have investigated other materials for fixing cartilage. We previously reported that absorbable sutures are more appropriate than wire. The present animal experiments investigated the reasons why fixation of transplanted cartilage is maintained when using absorbable sutures. METHODS The costal cartilages of Sprague-Dawley rats were harvested, and three cartilage transplant models were prepared. After bending a costal cartilage into a U-shape, it was fixed by using only absorbable sutures as the control or was fixed by suturing one or two cross struts of cartilage to the U-shaped graft. Then the cartilages were subcutaneously transplanted into the backs of the rats. They were removed 8 weeks later, and the return rate of the bent cartilages was assessed. RESULTS The return rate was 74.0%, in the suture-only group (control), 27.9% in the one-strut group, and 8.3% in the two-strut group. When the sites of contact between the U-shaped graft and the cartilage struts were observed by light microscopy, adhesion of the two cartilages by fibrous connective tissue was observed. CONCLUSION U-shaped cartilage grafts demonstrated a smaller return rate when there was a larger contact area with the cartilage struts. Each strut was fixed by fibrous connective tissue at the contact site, thereby maintaining the shape of the graft. Thus, when creating a cartilage framework, it is important to fix the bent cartilage to the cartilage struts with a sufficiently large contact area.
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Affiliation(s)
- Aritaka Sakamoto
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Hideaki Rikimaru
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Yukiko Rikimaru-Nishi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Koichi Watanabe
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Shinichiro Hashiguchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Tomonosin Kanazawa
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kei-Ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kensuke Kiyokawa
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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10
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Fu YY, Li CL, Zhang JL, Zhang TY. Autologous cartilage microtia reconstruction: Complications and risk factors. Int J Pediatr Otorhinolaryngol 2019; 116:1-6. [PMID: 30554677 DOI: 10.1016/j.ijporl.2018.09.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Brent or Nagata techniques of microtia reconstruction and their modifications involve complicated frameworks; therefore, complications are inevitable. The authors aimed to provide comprehensive knowledge regarding the occurrence, development, prognosis, risk factors, and treatment of complications. METHODS This study was a retrospective review of patients who underwent autologous cartilage microtia reconstruction at a single auricular plastic and reconstructive center between March 2005 and June 2016. Custom database software was used to process data from patients with microtia. Details of postoperative complications were collected during follow-up for analysis. RESULTS A total of 470 procedures (stage I) were performed on 429 patients. The mean (±SD) age at surgery was 12.27 ± 5.01 years (range, 6-32 years). The mean time to follow-up was 3.67 ± 2.45 years (range, 1-11 years). The complication rate was 2.98% (4/134) with the Brent technique and 12.2% (38/311) with the Nagata technique. A multivariate logistic regression analysis of complications of microtia reconstruction revealed that age, sex, and laterality were not associated with postoperative complications (p > 0.05). Surgical technique affected the incidence of complications. The Nagata technique resulted in a higher risk for complications (OR 6.14 [95% CI 1.63-23.19]; p < 0.01). CONCLUSION The development of complications was a dynamic process. There was a learning curve associated with autologous cartilage microtia reconstruction. Orthopedists or otologists aspiring to master microtia reconstruction should have a fundamental understanding of the procedure and be aware of possible complications.
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Affiliation(s)
- Yao-Yao Fu
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China; Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chen-Long Li
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China; Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jun-Li Zhang
- Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tian-Yu Zhang
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China; Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, China.
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11
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Castro NJ, O'Brien CM, Zhang LG. Biomimetic biphasic 3-D nanocomposite scaffold for osteochondral regeneration. AIChE J 2013. [DOI: 10.1002/aic.14296] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nathan J. Castro
- Dept. of Mechanical and Aerospace Engineering; The George Washington University; Washington DC 20052
| | - Christopher M. O'Brien
- Dept. of Mechanical and Aerospace Engineering; The George Washington University; Washington DC 20052
| | - Lijie Grace Zhang
- Dept. of Mechanical and Aerospace Engineering, Dept. of Medicine; The George Washington University; Washington DC 20052
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12
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Complication rate of autologous cartilage microtia reconstruction: a systematic review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e57. [PMID: 25289252 PMCID: PMC4174059 DOI: 10.1097/gox.0b013e3182aa8784] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
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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