A simple negative suction drain for ear reconstruction

Spring active drain using bladder (50-60ml) syringe (De Adotey's drain)

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The use of a spring mechanism could be fashioned with a syringe.

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De Adotey’s drain is a 60 ml bladder syringe with spring mechanism.

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The spring mechanism is used to provide a negative pressure which serves as an active drain.

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This is especially in a developing economy.

Introduction

Closed active drainage system with a syringe is an accepted way to let out fluid in a surgical wound. We present a simple spring active (negative suction) drainage (SAD) system using locally improvised metallic spring and 60 ml (bladder syringe); SAD of Adotey, a newly designed compression–expansion spring mechanism which serves especially in situations where an active drainage system is of utmost importance.

Conclusion

De Adotey's drain is a 60 ml bladder syringe with spring mechanism which is used to provide a negative pressure as an active drain.

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.

Two-stage reconstruction of the auricle in congenital microtia using autogenous costal cartilage

The current authors reconstructed the auricles of congenital microtia patients with a two-stage method using autogenous costal cartilage. In the first stage, lobule rotation, fabrication of the cartilage framework, and implantation of the framework were performed. In the second stage, elevation of the auricle using transplantation of the costal cartilage and two local transposition flaps, formation of the tragus, and deepening of the concha were performed. A total of 125 consecutive patients were treated, ranging from seven to 53 years old, from 1990 to 2003. Sixty-nine patients were males and 56 patients were females. Unilateral microtia was present in 114 patients (right 73, left 41), bilateral in 11 patients. Ninety-four cases were the classic sausage-shaped lobule type deformity; the remaining 42 cases presented concha-type deformity. The follow-up period was 6 months to 10 years. One hundred and eighteen cases presented acceptable ear contour after ear reconstruction. Unfavourable results were blunted convolution of the reconstructed ear because of thick fibrous tissue in six cases, mild absorption of carved cartilage by infection in two cases, deformation of the constructed helix occurred in four cases, less projection of the elevated ear in three cases, and hypertrophic scars in three cases. Our procedure produced acceptable contour of the reconstructed auricle with fewer complications than conventional procedures. In addition, careful meticulous manipulation is necessary to create natural contour of the ear and to reduce complications in all stages.

Surgical Results of Two-Stage Reconstruction of the Auricle in Congenital Microtia Using an Autogenous Costal Cartilage Alone or Combined with Canaloplasty

BACKGROUND

The authors performed two-stage ear reconstruction using autogenous costal cartilage alone or combined with canaloplasty of the acoustic meatus to improve the functional results with minimal operative stages.

METHODS

In the first stage, lobule transposition, fabrication of the cartilage framework, and implantation of the framework were performed. In the second stage, elevation of the auricle, coverage with the mastoid fascia flap and skin graft, and concha excavation were performed. Canaloplasty was combined simultaneously in 27 patients with radiologic and audiometric evidence of cochlear function.

RESULTS

A total of 37 cases in 36 consecutive patients with microtia were treated. Results of external ear reconstruction were evaluated by ear contour, quality of detail, and projection of the ear. Thirty-three cases presented acceptable ear contour after ear reconstruction. Unfavorable results were lack of detail of the reconstructed auricle in two patients and deformation of the constructed helix in one patient. Six patients exhibited improved hearing over 30 dB pure-tone average and three patients exhibited improved hearing below 30 dB after canaloplasty in the concha type. In the lobule type, seven patients demonstrated a greater than 30-dB gain in pure-tone average, six patients demonstrated a gain below 30 dB, and there was no improvement in five patients. Complications related to canaloplasty were chronic drainage of the auditory meatus in three cases and meatal stenosis in six cases.

CONCLUSIONS

The results of the contour of the reconstructed auricle with reduced operative stages combined with canaloplasty were acceptable to the patients. However, in lobule-type deformities, meticulous manipulation is necessary to reduce complications after canaloplasty.