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Kim HAJ, Namavarian A, Khan U, Levy BB, Ziai H, Talei B, Gantous A. Reconstructive Techniques in Pediatric Congenital Microtia: A Systematic Review and Meta-analysis. Facial Plast Surg 2024. [PMID: 38232751 DOI: 10.1055/a-2247-5109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Autografts and allografts are commonly used in microtia reconstruction. We aimed to systematically review and compare these reconstructive materials in pediatric congenital microtia reconstruction. A systematic review of the literature was performed. MEDLINE, Embase, PubMed, Web of Science, and CINAHL databases were searched for original studies on congenital microtia reconstruction in pediatric patients since database inception to 2021. Microtia grade was stratified as high or low. Meta-analysis of pooled proportions and continuous variables was performed using inverse variance weighting with a random effects model to compare between the autograft and allograft groups. Sixty-eight studies with a total of 5,546 patients used autografts (n = 5,382) or alloplastic implants (n = 164). Four other studies used prosthesis, cadaveric homografts, or tissue engineering. The allograft group was on average younger than the autograft group (8.4 vs. 11.1 years). There were no syndromic patients in the allograft group, compared to 43% in the autograft group. Patients treated with allografts had higher microtia grade than those treated with autograft (98 vs. 72%). Autografts were more commonly utilized by plastic surgeons and allografts by otolaryngologists (95 vs. 38%). No autografts and 41% of allografts were done concurrently with atresiaplasty or bone conduction implant. Satisfaction rates were similarly high (>90%) with similar complication rates (<10%). Microtia reconstruction using autografts and allografts had similar satisfaction and complication rates. Allografts were preferred for younger patients and concurrent hearing restoration. Further large-scale studies are required to evaluate the long-term efficacy of these reconstructive techniques.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amirpouyan Namavarian
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Urooj Khan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ben B Levy
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Ben Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Andres Gantous
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Su-Genyk P, Quatela O, Quatela V. Our Evolution of Approaches to Microtia Reconstruction. Facial Plast Surg Clin North Am 2024; 32:105-125. [PMID: 37981407 DOI: 10.1016/j.fsc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Microtia reconstruction is a complex procedure performed by the facial plastic and reconstructive surgeon and requires an expert understanding of the three-dimensional structure of the ear. This article provides an overview of the evolution of microtia reconstruction through history. Techniques pioneered by microtia surgeons Drs. Radford Tanzer, Burt Brent, Satoru Nagata, and Françoise Firmin will be described along with an additional excerpt on the utilization of porous polyethylene (Medpor; Stryker, USA). The objective for the reader is to be able to summarize approaches of each major reconstructive technique, compare the differences in techniques, and gain an understanding of the advantages and disadvantages of each approach.
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Affiliation(s)
- Peiyi Su-Genyk
- Quatela Center for Plastic Surgery, 973 East Avenue, Rochester, NY, USA
| | - Olivia Quatela
- Department of Otolaryngology, University at Buffalo, 1237 Delaware Avenue, Buffalo, NY 14209, USA.
| | - Vito Quatela
- Quatela Center for Plastic Surgery, 973 East Avenue, Rochester, NY, USA
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3
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Asirova G, Wynands J, Frolov S, Almeida D, Davydenko P, Madina S. Optimal surgical timing for ear reconstruction with autologous cartilage: Analysis of the computed tomography scan characteristics of the ribs. J Plast Reconstr Aesthet Surg 2024; 88:15-23. [PMID: 37950987 DOI: 10.1016/j.bjps.2023.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND The approach to constructing the cartilage framework for ear reconstruction is sufficiently established. However, there is still no consensus about the age of initiation of surgical treatment. This study aims to assess the development and growth of the costal cartilage to determine the best age to perform ear reconstruction surgery. METHODS Out of 107 patients, we used presurgical treatment data for 40 patients and medical records for 67 patients aged 5-40. Computed tomography (CT) scans were performed, and average parameters were calculated (length, width, thickness, cartilage density, and standard deviation in Hounsfield units) of the cartilaginous part of the 6th, 7th, 8th, and 9th ribs. RESULTS The required values were reached at 9-10 years old. CONCLUSION The criteria for starting surgical treatment in the Russian population was determined by the width of the 6th-7th ribs synchondrosis, which must be equal to the width of a healthy auricle, and the length of the 8th rib should be longer than 9 cm. Therefore, the optimal age for ear reconstruction with autologous costal cartilage is 10 years and older. However, reconstruction can be made earlier in specific cases, according to height and weight and the preoperative CT scan.
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Affiliation(s)
- Gerlya Asirova
- Department of Pediatric Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia; Department of Plastic and Reconstructive Surgery, Institute of Plastic Surgery and Cosmetology, Moscow, Russia.
| | - Jan Wynands
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Sergey Frolov
- Clinical Diagnostic Center, Medsi Group, Moscow, Russia
| | - Diana Almeida
- Department of Plastic and Reconstructive Surgery, Institute of Plastic Surgery and Cosmetology, Moscow, Russia; Department of Plastic surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Pavel Davydenko
- Department of Diagnostic Radiology, Central Bank of Russia Medical Center, Moscow, Russia
| | - Salem Madina
- Department of Plastic and Reconstructive Surgery, Institute of Plastic Surgery and Cosmetology, Moscow, Russia; Department of Plastic Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
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Wersényi G, Scheper V, Spagnol S, Eixelberger T, Wittenberg T. Cost-effective 3D scanning and printing technologies for outer ear reconstruction: current status. Head Face Med 2023; 19:46. [PMID: 37891625 PMCID: PMC10612312 DOI: 10.1186/s13005-023-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Current 3D scanning and printing technologies offer not only state-of-the-art developments in the field of medical imaging and bio-engineering, but also cost and time effective solutions for surgical reconstruction procedures. Besides tissue engineering, where living cells are used, bio-compatible polymers or synthetic resin can be applied. The combination of 3D handheld scanning devices or volumetric imaging, (open-source) image processing packages, and 3D printers form a complete workflow chain that is capable of effective rapid prototyping of outer ear replicas. This paper reviews current possibilities and latest use cases for 3D-scanning, data processing and printing of outer ear replicas with a focus on low-cost solutions for rehabilitation engineering.
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Affiliation(s)
| | - Verena Scheper
- Department of Otolaryngology, Hannover Medical School, Hannover, D-30625, Germany
| | | | - Thomas Eixelberger
- Friedrich-Alexander-University Erlangen-Nuremberg & Fraunhofer Institute for Integrated Circuits IIS, Erlangen, D-91058, Germany
| | - Thomas Wittenberg
- Friedrich-Alexander-University Erlangen-Nuremberg & Fraunhofer Institute for Integrated Circuits IIS, Erlangen, D-91058, Germany
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Ibrahiem SMS. Concha-Type Microtia: New Surgical Incision. Aesthet Surg J 2023; 43:NP815-NP822. [PMID: 37322857 DOI: 10.1093/asj/sjad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Reconstruction of auricles for conchal-type microtia is challenging but rewarding. Many plastic surgeons consider autogenous rib cartilage as the standard material for framework fabrication. A healthy, scar-free skin envelope and a defined cartilaginous framework are also critical to successful ear reconstruction. OBJECTIVES The aim of this study was to improve the outcome of the reconstruction and minimize complications by proposing a new surgical incision. METHODS Thirty-three patients who underwent auricular reconstruction of concha-type microtia of various etiologies with the new skin flap incision between 2017 and 2022 were included in the study. Patients' clinical data, detailed surgical techniques, and postoperative care were recorded. RESULTS Thirty-three patients (21 male, 12 female) were enrolled in the study. The mean age of the patients was 21.51 years at the time of reconstruction. The microtia was on the right side in 17 cases, on the left side in 12 cases, and 4 cases were bilateral; 12 cases were traumatic amputations of the helical component of the auricle, 11 cases were deformities after a burn, and 10 cases were congenital. The mean follow-up time was 17.43 months. A good initial projection without obvious scarring on the anterior surface of the auricle was achieved, with an overall complication rate of 5.42%. CONCLUSIONS The surgical incision recommended in the study improves the final aesthetic result of the technique without any additional surgical risk. LEVEL OF EVIDENCE: 4
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Hammad M, Veyssiere A, Leclercq S, Patron V, Baugé C, Boumédiene K. Hypoxia Differentially Affects Chondrogenic Differentiation of Progenitor Cells from Different Origins. Int J Stem Cells 2023; 16:304-314. [PMID: 37105555 PMCID: PMC10465331 DOI: 10.15283/ijsc21242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 04/29/2023] Open
Abstract
Background and Objectives Ear cartilage malformations are commonly encountered problems in reconstructive surgery, since cartilage has low self-regenerating capacity. Malformations that impose psychological and social burden on one's life are currently treated using ear prosthesis, synthetic implants or autologous flaps from rib cartilage. These approaches are challenging because not only they request high surgical expertise, but also they lack flexibility and induce severe donor-site morbidity. Through the last decade, tissue engineering gained attention where it aims at regenerating human tissues or organs in order to restore normal functions. This technique consists of three main elements, cells, growth factors, and above all, a scaffold that supports cells and guides their behavior. Several studies have investigated different scaffolds prepared from both synthetic or natural materials and their effects on cellular differentiation and behavior. Methods and Results In this study, we investigated a natural scaffold (alginate) as tridimensional hydrogel seeded with progenitors from different origins such as bone marrow, perichondrium and dental pulp. In contact with the scaffold, these cells remained viable and were able to differentiate into chondrocytes when cultured in vitro. Quantitative and qualitative results show the presence of different chondrogenic markers as well as elastic ones for the purpose of ear cartilage, upon different culture conditions. Conclusions We confirmed that auricular perichondrial cells outperform other cells to produce chondrogenic tissue in normal oxygen levels and we report for the first time the effect of hypoxia on these cells. Our results provide updates for cartilage engineering for future clinical applications.
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Affiliation(s)
- Mira Hammad
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
| | - Alexis Veyssiere
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
- Service de chirurgie Maxillo-faciale, CHU de Caen, Caen, France
| | - Sylvain Leclercq
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Clinique Saint Martin, Service de Chirurgie Orthopédique, Caen, France
| | - Vincent Patron
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Service ORL et chirurgie cervico-faciale, CHU de Caen, Caen, France
| | - Catherine Baugé
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
| | - Karim Boumédiene
- Normandy University, UNICAEN, EA 7451 BioConnecT, Caen, France
- Fédération Hospitalo Universitaire SURFACE, Amiens, Caen, France
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Truong MT, Liu YCC, Kohn J, Chinnadurai S, Zopf DA, Tribble M, Tanner PB, Sie K, Chang KW. Integrated microtia and aural atresia management. Front Surg 2022; 9:944223. [PMID: 36636584 PMCID: PMC9831057 DOI: 10.3389/fsurg.2022.944223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives To present recommendations for the coordinated evaluation and management of the hearing and reconstructive needs of patients with microtia and aural atresia. Methods A national working group of 9 experts on microtia and atresia evaluated a working document on the evaluation and treatment of patients. Treatment options for auricular reconstruction and hearing habilitation were reviewed and integrated into a coordinated care timeline. Results Recommendations were created for children with microtia and atresia, including diagnostic considerations, surgical and non-surgical options for hearing management and auricular reconstruction, and the treatment timeline for each option. These recommendations are based on the collective opinion of the group and are intended for otolaryngologists, audiologists, plastic surgeons, anaplastologists, and any provider caring for a patient with microtia and ear canal atresia. Close communication between atresia/hearing reconstruction surgeon and microtia repair surgeon is strongly recommended.
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Affiliation(s)
- Mai Thy Truong
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA
| | - Yi-Chun Carol Liu
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX,Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX
| | - Jocelyn Kohn
- Department of Otolaryngology-Head and Neck Surgery, Stanford Children's Hospital/Packard Children's Health Alliance, Walnut Creek, CA
| | - Sivakumar Chinnadurai
- Children's Minnesota Pediatric Otolaryngology and Facial Plastic Surgery, Minneapolis, MN,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - David A. Zopf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Tribble
- Department of Audiology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA
| | - Paul B. Tanner
- Department of Surgery, University of Utah, Facial Prosthetics, Salt Lake City, UT, USA
| | - Kathleen Sie
- Department of Otolaryngology-Head and Neck Surgery, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Kay W. Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA,Correspondence: Kay W. Chang
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Badawy MS, Elshahat A. Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear. J Craniofac Surg 2022; 33:1197-1200. [DOI: 10.1097/scs.0000000000008162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Flégeau K, Puiggali-Jou A, Zenobi-Wong M. Cartilage tissue engineering by extrusion bioprinting utilizing porous hyaluronic acid microgel bioinks. Biofabrication 2022; 14. [PMID: 35483326 DOI: 10.1088/1758-5090/ac6b58] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 11/11/2022]
Abstract
3D bioprinting offers an excellent opportunity to provide tissue-engineered cartilage to microtia patients. However, hydrogel-based bioinks are hindered by their dense and cell-restrictive environment, impairing tissue development and ultimately leading to mechanical failure of large scaffoldsin vivo. Granular hydrogels, made of annealed microgels, offer a superior alternative to conventional bioinks, with their improved porosity and modularity. We have evaluated the ability of enzymatically crosslinked hyaluronic acid (HA) microgel bioinks to form mature cartilagein vivo. Microgel bioinks were formed by mechanically sizing bulk HA-tyramine hydrogels through meshes with aperture diameters of 40, 100 or 500µm. Annealing of the microgels was achieved by crosslinking residual tyramines. Secondary crosslinked scaffolds were stable in solution and showed tunable porosity from 9% to 21%. Bioinks showed excellent rheological properties and were used to print different objects. Printing precision was found to be directly correlated to microgel size. As a proof of concept, freeform reversible embedding of suspended hydrogels printing with gelation triggered directly in the bath was performed to demonstrate the versatility of the method. The granular hydrogels support the homogeneous development of mature cartilage-like tissuesin vitrowith mechanical stiffening up to 200 kPa after 63 d. After 6 weeks ofin vivoimplantation, small-diameter microgels formed stable constructs with low immunogenicity and continuous tissue maturation. Conversely, increasing the microgel size resulted in increased inflammatory response, with limited stabilityin vivo. This study reports the development of new microgel bioinks for cartilage tissue biofabrication and offers insights into the foreign body reaction towards porous scaffolds implantation.
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Affiliation(s)
- Killian Flégeau
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, 8093 Zürich, Switzerland
| | - Anna Puiggali-Jou
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, 8093 Zürich, Switzerland
| | - Marcy Zenobi-Wong
- Tissue Engineering + Biofabrication Laboratory, Department of Health Sciences and Technology, ETH Zürich, 8093 Zürich, Switzerland
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10
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Lese I, Aldabbas M, Mazeed AS, Bulstrode NW. Lop Ear to Conchal Microtia: An Algorithmic Surgical Approach. Ann Plast Surg 2022; 88:188-194. [PMID: 35023869 DOI: 10.1097/sap.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience. MATERIALS AND METHODS All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded. RESULTS Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears. CONCLUSION We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.
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Affiliation(s)
| | - Mohammed Aldabbas
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Ahmed S Mazeed
- Department of Plastic and Reconstructive Surgery, Sohag Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, Egypt
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11
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Ikeda AK, Bhrany AD, Sie KCY, Bly RA. Management of patients with unilateral microtia and aural atresia: recent advances and updates. Curr Opin Otolaryngol Head Neck Surg 2021; 29:526-533. [PMID: 34545861 DOI: 10.1097/moo.0000000000000758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The management of patients with unilateral microtia and aural atresia is complex. Recent literature suggests significant strides in hearing habilitation and ear reconstruction. RECENT FINDINGS Several options of hearing management are available and are associated with improved outcomes. Timelines for hearing habilitation and ear reconstruction vary by institution. We offer our timeline as a reference. Three dimensional (3D) printed models are increasingly used for training and reconstruction. Bioprinting is on the horizon, though safety and effectiveness studies are pending. Lastly, application of qualitative methods has provided a foundation on which to improve communication between physicians and patients and their families. Better understanding of the patient and family experiences will provide opportunities to target interventions to improve care. SUMMARY Current developments include expanding options for hearing management, changing approaches to timing of atresiaplasty, utilization of 3D printed models, and focus on patient and family experience to improve reconstructive outcomes.
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Affiliation(s)
| | | | - Kathleen C Y Sie
- Department of Otolaryngology-Head and Neck Surgery
- Pediatric Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery
- Pediatric Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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12
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Prasetyo AT, Putri IL. Anthropometric Study of Human Ear: A Baseline Data for Ear Reconstruction. J Craniofac Surg 2021. [PMID: 34629382 DOI: 10.1097/SCS.0000000000008199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Creation of an auricular framework plays the main role on first stage of microtia reconstruction. The size of framework is determined based on the size of the contralateral healthy ear and customized with Nagata theory. The height of rib that added behind the previous framework is the same with the projection of the normal ear. But the height of rib needed and framework in bilateral cases is unknown. A population based auricular framework pattern and projection are urgently needed. OBJECTIVES This study aimed at determining the mean values of normal anthropometric measurement of external ear and projection of human ear in males and females and their comparison on either sides and in either sex. MATERIALS AND METHODS Measurements are taken from 524 subjects (96 men and 428 women) aged 17 to 35 years using a Vernier caliper. The parameters measured were total ear height, ear width, lobular height, lobular width, upper pole, middle upper pole, middle pole, lower middle pole, lower pole, each subject's right and left ears. RESULTS Comparisons between gender were performed by independent t test and paired t test for comparison between right and the left ear. All dimensions were significantly different between male and female (P < 0.05) except the right lobular height (P > 0.05). There was no significant difference both side among groups (P < 0.05) except total ear height on female group (P > 0.05). All projection dimensions were significantly different between male and female. There was no significant difference of auricular projection of right and left auricular on the male (P < 0.05) groups except the projection of lower pole. There were significant between auricular projection of right and left ears on the female groups (P > 0.05). CONCLUSIONS These findings suggest that the normal anthropometric study will have implication in the ear reconstruction especially on bilateral cases as a baseline for reconstruction.
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Al-Qurayshi Z, Wafa EI, Rossi Meyer MK, Owen S, Salem AK. Tissue Engineering the Pinna: Comparison and Characterization of Human Decellularized Auricular Biological Scaffolds. ACS Appl Bio Mater 2021; 4:7234-7242. [PMID: 34568774 PMCID: PMC8456428 DOI: 10.1021/acsabm.1c00766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022]
Abstract
Decellularization is one of the promising techniques in tissue engineering used to create a biological scaffold for subsequent repopulation with the patient's own cells. This study aims to compare two different decellularization protocols to optimize the process of auricle decellularization by assessing and characterizing the decellularization effects on human auricular cartilage. Herein, 12 pairs (8 females, 4 males) of freshly frozen adult human cadaveric auricles were de-epithelialized and defatted leaving only the cartilaginous framework. An auricle from each pair was randomly assigned to either protocol A (latrunculin B-based decellularization) or protocol B (trypsin-based decellularization). Gross examination of the generated scaffolds demonstrated preservation of the auricles' contours and a change in color from pinkish-white to yellowish-white. Hematoxylin and eosin staining demonstrated empty cartilaginous lacunae in both study groups, which confirms the depletion of cells. However, there was greater preservation of the extracellular matrix in auricles decellularized with protocol A as compared to protocol B. Comparing protocol A to protocol B, Masson's trichrome and Safranin-O stains also demonstrated noticeable preservation of collagen and proteoglycans, respectively. Additionally, scanning electron micrographs demonstrated preservation of the cartilaginous microtopography in both study groups. Biomechanical testing demonstrated a substantial decrease in Young's modulus after decellularization using protocol B (1.3 MPa), albeit not significant (P-value > 0.05) when compared to Young's modulus prior to decellularization (2.6 MPa) or after decellularization with protocol A (2.7 MPa). A DNA quantification assay demonstrated a significant drop (P-value < 0.05) in the DNA content after decellularization with protocol A (111.0 ng/mg) and protocol B (127.6 ng/mg) in comparison to before decellularization (865.3 ng/mg). Overall, this study demonstrated effective decellularization of human auricular cartilage, and it is concluded that protocol A provided greater preservation of the extracellular matrix and biomechanical characteristics. These findings warrant proceeding with the assessment of inflammation and cell migration in a decellularized scaffold using an animal model.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department
of Otolaryngology − Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, United States
| | - Emad I. Wafa
- Department
of Pharmaceutical Sciences and Experimental Therapeutics, College
of Pharmacy, University of Iowa, Iowa City, Iowa 52242, United States
| | - Monica K. Rossi Meyer
- Department
of Otolaryngology − Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, United States
| | - Scott Owen
- Department
of Otolaryngology − Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, United States
| | - Aliasger K. Salem
- Department
of Pharmaceutical Sciences and Experimental Therapeutics, College
of Pharmacy, University of Iowa, Iowa City, Iowa 52242, United States
- Holden
Comprehensive Cancer Center, University
of Iowa, Iowa City, Iowa 52242, United States
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Kennedy NS, Lloyd MS. A Single Surgeon's Experience of Starting a New Ear Reconstruction Service in the UK. J Craniofac Surg 2021; 32:1785-7. [PMID: 33481469 DOI: 10.1097/SCS.0000000000007452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Autologous ear reconstruction is known as one of the most difficult types of reconstruction to perform in plastic surgery. Very rarely is a trainee exposed to the level of complexity and variety of cases they will treat as a sole care provider in a tertiary care setting. This is because the learning curve is steep and those few surgeons that already perform ear reconstruction are limited in what technical experience they can offer trainees due to the plethora of factors competing against the surgeon. These include patient expectations, level of experience, length of anesthetic and accountability for results and complications. For this reason, once a plastic surgeon is nominated to provide autologous ear reconstruction, they face the daunting prospect of not only performing what is a very complex surgery with a very steep learning curve but also the judgment of their patients and colleagues. This paper charts the endeavors of the senior author to provide a service over the last 5 years. It will hopefully provide insight and context on setting up a service, dealing with complications, patient and peer expectations, and finally acknowledgment from both alike as experience is gained and excellence is reached.
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Apelgren P, Amoroso M, Säljö K, Montelius M, Lindahl A, Stridh Orrhult L, Gatenholm P, Kölby L. Vascularization of tissue engineered cartilage - Sequential in vivo MRI display functional blood circulation. Biomaterials 2021; 276:121002. [PMID: 34274777 DOI: 10.1016/j.biomaterials.2021.121002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
Establishing functional circulation in bioengineered tissue after implantation is vital for the delivery of oxygen and nutrients to the cells. Native cartilage is avascular and thrives on diffusion, which in turn depends on proximity to circulation. Here, we investigate whether a gridded three-dimensional (3D) bioprinted construct would allow ingrowth of blood vessels and thus prove a functional concept for vascularization of bioengineered tissue. Twenty 10 × 10 × 3-mm 3Dbioprinted nanocellulose constructs containing human nasal chondrocytes or cell-free controls were subcutaneously implanted in 20 nude mice. Over the next 3 months, the mice were sequentially imaged with a 7 T small-animal MRI system, and the diffusion and perfusion parameters were analyzed. The chondrocytes survived and proliferated, and the shape of the constructs was well preserved. The diffusion coefficient was high and well preserved over time. The perfusion and diffusion patterns shown by MRI suggested that blood vessels develop over time in the 3D bioprinted constructs; the vessels were confirmed by histology and immunohistochemistry. We conclude that 3D bioprinted tissue with a gridded structure allows ingrowth of blood vessels and has the potential to be vascularized from the host. This is an essential step to take bioengineered tissue from the bench to clinical practice.
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Affiliation(s)
- Peter Apelgren
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden.
| | - Matteo Amoroso
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Karin Säljö
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Mikael Montelius
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindahl
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Linnea Stridh Orrhult
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Paul Gatenholm
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
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16
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Chiesa-Estomba CM, Aiastui A, González-Fernández I, Hernáez-Moya R, Rodiño C, Delgado A, Garces JP, Paredes-Puente J, Aldazabal J, Altuna X, Izeta A. Three-Dimensional Bioprinting Scaffolding for Nasal Cartilage Defects: A Systematic Review. Tissue Eng Regen Med 2021; 18:343-353. [PMID: 33864626 PMCID: PMC8169726 DOI: 10.1007/s13770-021-00331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, three-dimensional (3D)-printing of tissue-engineered cartilaginous scaffolds is intended to close the surgical gap and provide bio-printed tissue designed to fit the specific geometric and functional requirements of each cartilage defect, avoiding donor site morbidity and offering a personalizing therapy. METHODS To investigate the role of 3D-bioprinting scaffolding for nasal cartilage defects repair a systematic review of the electronic databases for 3D-Bioprinting articles pertaining to nasal cartilage bio-modelling was performed. The primary focus was to investigate cellular source, type of scaffold utilization, biochemical evaluation, histological analysis, in-vitro study, in-vivo study, animal model used, length of research, and placement of experimental construct and translational investigation. RESULTS From 1011 publications, 16 studies were kept for analysis. About cellular sources described, most studies used primary chondrocyte cultures. The cartilage used for cell isolation was mostly nasal septum. The most common biomaterial used for scaffold creation was polycaprolactone alone or in combination. About mechanical evaluation, we found a high heterogeneity, making it difficult to extract any solid conclusion. Regarding biological and histological characteristics of each scaffold, we found that the expression of collagen type I, collagen Type II and other ECM components were the most common patterns evaluated through immunohistochemistry on in-vitro and in-vivo studies. Only two studies made an orthotopic placement of the scaffolds. However, in none of the studies analyzed, the scaffold was placed in a subperichondrial pocket to rigorously simulate the cartilage environment. In contrast, scaffolds were implanted in a subcutaneous plane in almost all of the studies included. CONCLUSION The role of 3D-bioprinting scaffolding for nasal cartilage defects repair is growing field. Despite the amount of information collected in the last years and the first surgical applications described recently in humans. Further investigations are needed due to the heterogeneity on mechanical evaluation parameters, the high level of heterotopic scaffold implantation and the need for quantitative histological data.
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Affiliation(s)
- Carlos M Chiesa-Estomba
- Otorhinolaryngology - Head and Neck surgery Department, Osakidetza Basque Health Service, Donostia University Hospital, 20014, San Sebastian, Spain.
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain.
| | - Ana Aiastui
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
- Biodonostia Health Research Institute, Histology Platform, 20014, San Sebastian, Spain
| | | | - Raquel Hernáez-Moya
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
| | - Claudia Rodiño
- Biodonostia Health Research Institute, Histology Platform, 20014, San Sebastian, Spain
| | - Alba Delgado
- Biodonostia Health Research Institute, Histology Platform, 20014, San Sebastian, Spain
| | - Juan P Garces
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
- Department of Pathology, Osakidetza Basque Health Service, Donostia University Hospital, 20014, San Sebastian, Spain
| | - Jacobo Paredes-Puente
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
- Tecnun-University of Navarra, Pso. Mikeletegi 48, 20009, San Sebastian, Spain
| | - Javier Aldazabal
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
- Tecnun-University of Navarra, Pso. Mikeletegi 48, 20009, San Sebastian, Spain
| | - Xabier Altuna
- Otorhinolaryngology - Head and Neck surgery Department, Osakidetza Basque Health Service, Donostia University Hospital, 20014, San Sebastian, Spain
| | - Ander Izeta
- Multidisciplinary 3D Printing Platform (3DPP), Biodonostia Health Research Institute, 20014, San Sebastian, Spain
- Tecnun-University of Navarra, Pso. Mikeletegi 48, 20009, San Sebastian, Spain
- Tissue Engineering Group, Biodonostia Health Research Institute, 20014, San Sebastian, Spain
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Abdelnor SAY, Darwish AM, Abdalla MSF, Ismail MT. Optimizing auricular carving training using two materials: synthetic foam and bovine cartilage. Eur J Plast Surg 2021; 44:9-16. [DOI: 10.1007/s00238-020-01745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Apelgren P, Amoroso M, Säljö K, Lindahl A, Brantsing C, Stridh Orrhult L, Markstedt K, Gatenholm P, Kölby L. Long-term in vivo integrity and safety of 3D-bioprinted cartilaginous constructs. J Biomed Mater Res B Appl Biomater 2021; 109:126-136. [PMID: 32633102 DOI: 10.1002/jbm.b.34687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 11/07/2022]
Abstract
Long-term stability and biological safety are crucial for translation of 3D-bioprinting technology into clinical applications. Here, we addressed the long-term safety and stability issues associated with 3D-bioprinted constructs comprising a cellulose scaffold and human cells (chondrocytes and stem cells) over a period of 10 months in nude mice. Our findings showed that increasing unconfined compression strength over time significantly improved the mechanical stability of the cell-containing constructs relative to cell-free scaffolds. Additionally, the cell-free constructs exhibited a mean compressive stress and stiffness (compressive modulus) of 0.04 ± 0.05 MPa and 0.14 ± 0.18 MPa, respectively, whereas these values for the cell-containing constructs were 0.11 ± 0.08 MPa (p = .019) and 0.53 ± 0.59 MPa (p = .012), respectively. Moreover, histomorphologic analysis revealed that cartilage formed from the cell-containing constructs harbored an abundance of proliferating chondrocytes in clusters, and after 10 months, resembled native cartilage. Furthermore, extension of the experiment over the complete lifecycle of the animal model revealed no signs of ossification, fibrosis, necrosis, or implant-related tumor development in the 3D-bioprinted constructs. These findings confirm the in vivo biological safety and mechanical stability of 3D-bioprinted cartilaginous tissues and support their potential translation into clinical applications.
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Affiliation(s)
- Peter Apelgren
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
| | - Matteo Amoroso
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
| | - Karin Säljö
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
| | - Anders Lindahl
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Camilla Brantsing
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Linnéa Stridh Orrhult
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Kajsa Markstedt
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Paul Gatenholm
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Göteborg, Sweden
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Banda CH, Narushima M, Mitsui K, Danno K, Fujita M, Furuya M, Karakawa R, Ogishima S, Ishiura R. Posterior auricular artery free flap reconstruction of the retroauricular sulcus in microtia repair. J Plast Reconstr Aesthet Surg 2020; 74:2349-2357. [PMID: 33518502 DOI: 10.1016/j.bjps.2020.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Autologous repair using costal cartilage grafts remains the most widely accepted method of microtia reconstruction. A major complication of current techniques is loss of ear shape caused by scarring, contracture and cartilage absorption. We present a new surgical technique utilizing the posterior auricular artery free flap in microsurgical reconstruction of the retroauricular sulcus in microtia. METHOD Reconstruction is performed in two stages. In the first stage, a fabricated costal cartilage framework is inserted into a skin pocket as described by Nagata. In the second stage, the ear framework is elevated from the scalp and held by an additional cartilage wedge. Following indocyanine green angiography perforator mapping, a posterior auricular artery perforator flap is harvested from the contralateral (normal) ear and used to reconstruct the posterior auricular sulcus covering the cartilage framework and elevating wedge. RESULTS The technique was applied to three patients aged 11-15 years with a follow-up time of 8 months to 3 years. The average flap artery diameter was 0.73 mm and the vein was 0.7 mm. Venous congestion occurred in one case and was resolved with a vein graft leading to complete flap recovery. Good ear shape, elevation, projection, skin color and texture were achieved in all the cases. CONCLUSION Posterior auricular artery flap reconstruction of the retroauricular sulcus in microtia repair is a useful alternative to the current skin graft and tissue expander-based techniques. It provides the ideal skin color and texture match and may improve the overall results of microtia reconstruction by enhancing vascularity.
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Affiliation(s)
- Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan.
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Minami Fujita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Megumi Furuya
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Ogishima
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan
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20
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Mazeed AS, O'Hara J, Bulstrode NW. Modification of the cartilaginous framework for autologous ear reconstruction: Construction of a stable complete ring framework with grander highs and lows. J Plast Reconstr Aesthet Surg 2020; 74:1832-1839. [PMID: 33451946 DOI: 10.1016/j.bjps.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/08/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Successful microtia reconstruction involves fabrication of a framework with well-defined ear subunits. Tragal definition and deep conchal bowl are key elements to produce a natural well-defined and contoured ear. We describe a modification in the cartilage framework with the purpose of increasing framework stability, tragal definition and conchal bowl depth. METHODS The tragus is placed on two cartilaginous bars (L-shaped), which are fixed to the framework base block creating a complete ring. These increase tragal projection and conchal depth. The tragus is carved angled posteriorly to have a shadowing effect on the absent auditory canal. Aesthetic outcome was assessed, at least 6 months after the second stage, on a 5-point ordinal scale (1-5) using the scoring system published in the UK microtia care standards and agreed on by the International Society for Auricular Reconstruction (ISAR). RESULTS A total of 406 auricular reconstructions were performed in 363 patients (206 right, 114 left, 43 bilateral). After excluding cases who did not have second stage and those without complete photographs, 290 cases were assessed. The described modification in the framework carving was performed in 255 ears out of these 290 ears. The mean aesthetic score before and after the modification was 2.4 and 3.09 respectively for the tragus (p < 0.001), 2.2 and 2.95 for the intertragal notch (p < 0.001) and 2.77 and 3.49 for the concha (p < 0.001). CONCLUSIONS This technical refinement has resulted in increased permanence and definition of the tragus and deeper and more aesthetic concha.
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Affiliation(s)
- Ahmed S Mazeed
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom; Department of Plastic and Reconstructive Surgery, Sohag Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, Egypt.
| | - Justine O'Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Neil W Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom; Institute of Child Health, University College London, United Kingdom
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21
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Li D, Zhang R, Zhang Q, Xu Z, Xu F, Li Y, Chen X. Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective Study. Aesthetic Plast Surg 2020; 44:1545-1552. [PMID: 32300879 DOI: 10.1007/s00266-020-01711-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skin grafts, frequently used for ear elevation in ear reconstructions, may suffer from color mismatches, scar hypertrophy, secondary contraction, and auricular sulcus depth differences. To determine the most suitable donor area, we compared the contralateral postauricular area, groin, and scalp as potential donor sites. METHODS Since 2008, we have used three donor sites for obtaining skin grafts used in ear reconstructions. Full-thickness groin skin, split-thickness grafts from the scalp, and contralateral postauricular and groin composite full-thickness skin grafts were used in 202, 231, and 195 patients, respectively. Photographic assessments were used to assess color matching, sulcus depth, cranioauricular angle symmetry, and flatness of the skin grafts; surgical complications were also documented. RESULTS Among the three donor sites, there were no significant differences in the color matching scores (p = 0.456). The scalp donor scores had significantly lower mean scores for sulcus depth and symmetry and for graft flatness scores than the other donor sites. The assessment scores between the groin and postauricular donor groups were similar. Each donor site was associated with some surgical complications. However, postauricular skin, when combined with groin skin, demonstrated the best cosmetic results and the fewest complications. CONCLUSION All three donor sites are viable options for skin graft donor sites in ear elevation surgeries. Although the advantages and disadvantages of each site should be explained to the patient, the ultimate donor site selection may be determined according to patient and surgeon preferences. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Jovic TH, Combellack EJ, Jessop ZM, Whitaker IS. Using 3D Printing Technology to Teach Cartilage Framework Carving for Ear Reconstruction. Front Surg 2020; 7:44. [PMID: 32766275 PMCID: PMC7380086 DOI: 10.3389/fsurg.2020.00044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/10/2020] [Indexed: 01/21/2023] Open
Abstract
Objective: The aim of this study was to determine the validity of using a carvable 3D printed rib model in combination with a 3D printed auricular framework to facilitate the teaching, training and planning of auricular reconstruction. Design: 3D printed costal cartilages from ribs 6-9 were produced using a FormLabs Form3 Printer and used to make negative molds. 2:1 silicone-cornstarch mixture was added to each mold to make 12 simulated 6-9th costal cartilages suitable for carving. 3D printed auricular frameworks were produced in polylactic acid using an Ultimaker 3 3D printer to demonstrate the component parts and constructed framework of an auricular reconstruction. Participants: Twelve plastic surgery trainees attended a workshop in which they each attempted auricular reconstruction using the carvable models and 3D printed plastic models as a guide. All candidates completed a pre- and post-training questionnaire to assess confidence and comprehension of auricular reconstruction, and the suitability of the models for facilitating this teaching. Results: Only 42% of trainees (n = 5) had observed an ear reconstruction in theater prior to the training course. Statistically significant improvements in the appreciation of the different components that make an auricular framework (p < 0.0001) and confidence in carving and handling costal cartilage (p < 0.0001) were noted following completion of the training. Highly significant improvements in comprehension of the approach to ear reconstruction (p = 0.006) and locating the subunits of a reconstructed ear from costal cartilage (p = 0.003) were also noted. 100% of participants felt the 3D printed teaching aids directly enhanced their learning. Conclusions: Ear reconstruction is a complex, time consuming multi-stage operation demanding significant amounts of experience, planning and an appreciation of the 3D chondrocutaneous structure. In this study we have demonstrated the value of 3D printing in producing a suitable simulated costal cartilage model and as an adjunct to comprehending and planning a framework for auricular reconstruction.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Emman J Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Zita M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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23
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Mazeed AS, Bulstrode NW. Refinements in autologous ear reconstruction: descriptive surgical technique and experience of 400 consecutive cases at a tertiary referral center in the UK. Eur J Plast Surg 2020. [DOI: 10.1007/s00238-019-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salvador Vergés À, Yildirim M, Salvador B, Garcia Cuyas F. Trends in Scientific Reports on Cartilage Bioprinting: Scoping Review. JMIR Form Res 2019; 3:e15017. [PMID: 31464195 PMCID: PMC6737890 DOI: 10.2196/15017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background Satisfactory therapeutic strategies for cartilaginous lesion repair do not yet exist. This creates a challenge for surgeons and biomedical engineers and leads them to investigate the role of bioprinting and tissue engineering as viable treatments through orthopedic surgery, plastic surgery, and otorhinolaryngology. Recent increases in related scientific literature suggest that bioprinted cartilage may develop into a viable solution. Objective The objectives of this review were to (1) synthesize the scientific advances published to date, (2) identify unresolved technical problems regarding human application, and (3) identify more effective ways for the scientific community to transfer their findings to clinicians. Methods This scoping review considered articles published between 2009 and 2019 that were identified through searching PubMed, Scopus, Web of Science, and Google Scholar. Arksey and O'Malley’s five-step framework was used to delimit and direct the initial search results, from which we established the following research questions: (1) What do authors of current research say about human application? (2) What necessary technical improvements are identified in the research? (3) On which issues do the authors agree? and (4) What future research priorities emerge in the studies? We used the Cohen kappa statistic to validate the interrater reliability. Results The 13 articles included in the review demonstrated the feasibility of cartilage bioprinting in live animal studies. Some investigators are already considering short-term human experimentation, although technical limitations still need to be resolved. Both the use and manufacturing process of stem cells need to be standardized, and a consensus is needed regarding the composition of hydrogels. Using on-site printing strategies and predesigned implants may allow techniques to adapt to multiple situations. In addition, the predictive capacity of implant behavior may lead to optimal results. Conclusions Cartilage bioprinting for surgical applications is nearing its initial use in humans. Current research suggests that surgeons will soon be able to replace damaged tissue with bioprinted material.
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Affiliation(s)
- Àngels Salvador Vergés
- Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences, Department of Nursing, Faculty of Health Sciences and Welfare, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
| | - Bertran Salvador
- Communication Department, University Pompeu Fabra, Barcelona, Spain
| | - Francesc Garcia Cuyas
- Catalan Society of Digital Health, Hospital Sant Joan de Déu, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
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Duisit J, Orlando G, Debluts D, Maistriaux L, Xhema D, de Bisthoven YJ, Galli C, Peloso A, Behets C, Lengelé B, Gianello P. Decellularization of the Porcine Ear Generates a Biocompatible, Nonimmunogenic Extracellular Matrix Platform for Face Subunit Bioengineering. Ann Surg 2018; 267:1191-201. [PMID: 28252516 DOI: 10.1097/SLA.0000000000002181] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to assess whether perfusion-decellularization technology could be applied to facial grafts. BACKGROUND Facial allotransplantation remains an experimental procedure. Regenerative medicine techniques allow fabrication of transplantable organs from an individual's own cells, which are seeded into extracellular matrix (ECM) scaffolds from animal or human organs. Therefore, we hypothesized that ECM scaffolds also can be created from facial subunits. We explored the use of the porcine ear as a clinically relevant face subunit model to develop regenerative medicine-related platforms for facial bioengineering. METHODS Porcine ear grafts were decellularized and histologic, immunologic, and cell culture studies done to determine whether scaffolds retained their 3D framework and molecular content; were biocompatible in vitro and in vivo, and triggered an anti-MHC immune response from the host. RESULTS The cellular compartment of the porcine ear was completely removed except for a few cartilaginous cells, leaving behind an acellular ECM scaffold; this scaffold retained its complex 3D architecture and biochemical components. The framework of the vascular tree was intact at all hierarchical levels and sustained a physiologically relevant blood pressure when implanted in vivo. Scaffolds were biocompatible in vitro and in vivo, and elicited no MHC immune response from the host. Cells from different types remained viable and could even differentiate at the scale of a whole-ear scaffold. CONCLUSIONS Acellular scaffolds were produced from the porcine ear, and may be a valuable platform to treat facial deformities using regenerative medicine approaches.
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Mazeed AS, Saied S, Abulezz T, Youssef G, Bulstrode NW. Recommendations for the Development and Reform of Microtia and Atresia Services. J Craniofac Surg 2019; 30:1135-9. [PMID: 31166258 DOI: 10.1097/SCS.0000000000005209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The initial step in setting up standardized microtia-atresia service is investigating the current status of the service and comparing this to internationally recognized guidelines or care standards. In many countries, documented information about microtia care is lacking. This study is an initiative to guide reform efforts of national microtia service in any country. The UK care standards for microtia-atresia can be a useful model to help set up a comprehensive microtia-atresia service. METHODS The authors conducted a survey to investigate different aspects of microtia service in Egypt. The major plastic surgery centers (n = 22) were surveyed by a structured questionnaire. The results were compared with the UK care standards for microtia-atresia to identify the aspects that need improvement. Thorough analysis of the main problems in microtia-atresia service is presented. RESULTS The authors found that microtia service is fragmented between the surveyed centers with 65% of the centers treating less than 10 microtia cases annually. Multiple surgeons are responsible for ear reconstruction in 90% of centers and only 25% of them practise a multidisciplinary team approach. None of the centers uses validated tools of aesthetic or psychological patient-reported outcome measures. RECOMMENDATIONS These 5 recommendations are the keys to reforming microtia service in any country:(1) Establishing nationally designated centers to concentrate the required expertise.(2) Assigning fewer high-volume surgeons to optimize the surgical outcomes.(3) Providing treatment by experienced multidisciplinary teams.(4) Using validated tools of patient-reported outcome measures.(5) Collecting and keeping standardized records for regular audit and intercenter studies.
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Parri F, Alonso V, Albert A, Bejarano M, Vicario F, Rubio-Palau J. Auricular Reconstructive Surgery Improvement to the Firmin Technique for Placing an Earring. Cleft Palate Craniofac J 2019; 56:1260-1262. [PMID: 30974952 DOI: 10.1177/1055665619842727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Microtia has an incidence of 1 in 7000 to 8000 births. Ear reconstruction has 2 main aims: reconstructive and aesthetic, and a considerable number of patients ask for an earring at the end of their treatment. Herein, we explain our team's modification to the Firmin technique, perforating the lowest part of the autologous cartilage framework (Parri's modification). The orifice is cartilaginous and the skin covering both sides is easily perforable without contacting the rest of the framework. In conclusion, our modification for placing an earring is simple; it does not increase the surgical time and contributes to approach the perfection of auricular reconstructive surgery.
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Affiliation(s)
- Francisco Parri
- 1 Plastic Pediatric Surgery Department, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Veronica Alonso
- 2 Department of Pediatric Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Asteria Albert
- 3 Department of Plastic Pediatric Surgery, Sant Joan de Deu Hospital, Barcelona, Spain.,4 Medicine Faculty, Barcelona University, Barcelona, Spain
| | - Miguel Bejarano
- 5 Department of Plastic Pediatric Surgery, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Francisco Vicario
- 6 Pediatric Surgery Resident, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Josep Rubio-Palau
- 7 Department of Maxillofacial-Plastic Pediatric Surgery, Sant Joan de Deu Hospital, Barcelona, Spain
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Apelgren P, Karabulut E, Amoroso M, Mantas A, Martínez Ávila H, Kölby L, Kondo T, Toriz G, Gatenholm P. In Vivo Human Cartilage Formation in Three-Dimensional Bioprinted Constructs with a Novel Bacterial Nanocellulose Bioink. ACS Biomater Sci Eng 2019; 5:2482-2490. [DOI: 10.1021/acsbiomaterials.9b00157] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Apelgren
- Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg 41685, Sweden
| | - Erdem Karabulut
- 3D Bioprinting Center, BBV at Biotech Center, Gothenburg 41346, Sweden
- Wallenberg Wood Science Center, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg 41296, Sweden
| | - Matteo Amoroso
- Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg 41685, Sweden
| | - Athanasios Mantas
- 3D Bioprinting Center, BBV at Biotech Center, Gothenburg 41346, Sweden
| | | | - Lars Kölby
- Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg 41685, Sweden
| | - Tetsuo Kondo
- Biomacromolecular Materials Lab, and Biomaterial Design Lab, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, 6-10-1, Hakozaki, Higashi-ku, Fukuoka 812-8581, Japan
| | - Guillermo Toriz
- Wood, Cellulose and Paper Research, University of Guadalajara, Guadalajara 44100, Mexico
| | - Paul Gatenholm
- 3D Bioprinting Center, BBV at Biotech Center, Gothenburg 41346, Sweden
- Wallenberg Wood Science Center, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg 41296, Sweden
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Denadai R, Raposo-Amaral CE, Zanco GL, Raposo-Amaral CA. Autologous Ear Reconstruction for Microtia Does Not Result in Loss of Cutaneous Sensitivity. Plast Reconstr Surg 2019; 143:808e-19e. [PMID: 30921140 DOI: 10.1097/PRS.0000000000005485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cutaneous sensitivity of microtia reconstruction has been sparsely documented. The purpose of this study was to evaluate whether there is a loss of cutaneous sensitivity following two-stage autologous ear reconstruction for unilateral microtia. METHODS A prospective study was performed including unilateral microtia patients who underwent two-stage autologous ear reconstruction performed by a single plastic surgeon between 2011 and 2016. Standardized sensory testing (i.e., temperature discrimination and Semmes-Weinstein monofilaments) was executed at 11 predefined anatomical points of the affected and unaffected ears preoperatively and at 6 and 12 months postoperatively. RESULTS Thirty-eight patients were included. Affected and unaffected sides presented similar (all p > 0.05) preoperative cutaneous sensitivity. Most (72.7 percent) of the tested points showed (all p < 0.05) preservation or recovery of cutaneous sensitivity at 12 months postoperatively. When comparing the reconstructed ears with the unaffected ears, there was no significant difference (all p > 0.05) in most (72.7 percent) of the tested points, except (all p < 0.05) at those points involving the postauricular sulcus. CONCLUSION There is a temporary cutaneous sensitivity loss after a two-stage autologous microtia reconstruction, which returned to similar preoperative sensitivity at 12-month follow-up, except in the postauricular sulcus. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
This historical literature review of ear reconstruction differs from much of the published literature in that it focuses on the biographies of the innovators and evangelists of ear reconstruction rather than specific techniques. A biographical account of ear reconstruction demonstrates the importance of surgeons as artists, scientists, technicians, politicians, and most importantly carers of this special and fascinating group of patients who benefit from this technically challenging form of reconstruction.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
The known classifications for microtia have been cumbersome and difficult to apply in daily consultation. The lack of a progressive surgical behavior according to each degree of affection also contributes to confusion and in a lower success rate in clinical application. The authors propose a progressive surgical classification that takes into consideration the principal anatomical defect and the corresponding correction with modern techniques, having eliminated from previous classifications, those elements that are now considered deformations of the ear, capable of conservative treatment in early stages of life.
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Abstract
Infants may be born with external ear deformities or malformations that can present a diagnostic clue to an affiliated syndrome while also presenting the possibility of surgical intervention. Microtia is a malformation of the ear that is associated with other craniofacial or systemic anomalies in 50% of cases. Surgical correction of microtia and associated facial anomalies is complex and must be integrated thoughtfully into the overall care plan for children with complex medical needs. Familiarity with types of ear and facial anomalies and their association with more global concerns can allow perinatal practitioners to better serve their patients.
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Apelgren P, Amoroso M, Säljö K, Lindahl A, Brantsing C, Stridh Orrhult L, Gatenholm P, Kölby L. Skin Grafting on 3D Bioprinted Cartilage Constructs In Vivo. Plast Reconstr Surg Glob Open 2018; 6:e1930. [PMID: 30349794 PMCID: PMC6191239 DOI: 10.1097/gox.0000000000001930] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/13/2018] [Indexed: 01/20/2023]
Abstract
Background: Three-dimensional (3D) bioprinting of cartilage is a promising new technique. To produce, for example, an auricle with good shape, the printed cartilage needs to be covered with skin that can grow on the surface of the construct. Our primary question was to analyze if an integrated 3D bioprinted cartilage structure is a tissue that can serve as a bed for a full-thickness skin graft. Methods: 3D bioprinted constructs (10 × 10 × 1.2 mm) were printed using nanofibrillated cellulose/alginate bioink mixed with mesenchymal stem cells and adult chondrocytes and implanted subcutaneously in 21 nude mice. Results: After 45 days, a full-thickness skin allograft was transplanted onto the constructs and the grafted construct again enclosed subcutaneously. Group 1 was sacrificed on day 60, whereas group 2, instead, had their skin-bearing construct uncovered on day 60 and were sacrificed on day 75 and the explants were analyzed morphologically. The skin transplants integrated well with the 3D bioprinted constructs. A tight connection between the fibrous, vascularized capsule surrounding the 3D bioprinted constructs and the skin graft were observed. The skin grafts survived the uncovering and exposure to the environment. Conclusions: A 3D bioprinted cartilage that has been allowed to integrate in vivo is a sufficient base for a full-thickness skin graft. This finding accentuates the clinical potential of 3D bioprinting for reconstructive purposes.
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Affiliation(s)
- Peter Apelgren
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Matteo Amoroso
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Karin Säljö
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anders Lindahl
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicin, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Camilla Brantsing
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicin, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Linnéa Stridh Orrhult
- Department of Chemistry and Chemical Engineering, 3D Bioprinting Centre, Chalmers University of Technology, Göteborg, Sweden
| | - Paul Gatenholm
- Department of Chemistry and Chemical Engineering, 3D Bioprinting Centre, Chalmers University of Technology, Göteborg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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Li Q, Zhou X, Wang Y, Qian J, Zhang Q. Auricular reconstruction of congenital microtia by using the modified Nagata method: Personal 10-Year experience with 1350 cases. J Plast Reconstr Aesthet Surg 2018; 71:1462-1468. [PMID: 30097399 DOI: 10.1016/j.bjps.2018.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Total auricular reconstruction is currently one of the most challenging plastic surgery procedures. Herein, we present our 10-year experience with 1350 cases of ear reconstruction by using Nagata method with necessary improvement. METHODS Factors related to ear reconstruction, namely, remnant ear, mastoid skin, adjacent scalp, rib cartilages, normal ear, and mastoid process, were carefully evaluated before operation. An individualized design and precise framework fabrication were performed for each patient. Necessary modifications in fabricating base frame, helix, tragus, and antihelix were introduced to achieve a stable and individualized framework. These efforts also reduced the quantity of cartilage required for ear reconstruction. RESULTS Follow-up time ranged from 1 month to 5 years, and 1217 (90.1%) patients were satisfied with the reconstructed ears, which showed appropriate color, texture, size, and location. The modifications made conferred a harmonious and individualized contour of the reconstructed ears. Incidence of all complications such as hematoma, skin necrosis, and framework absorption was very low. CONCLUSIONS Based on preoperative assessment, individualized design, and precise sculpting, a harmonious and individual auricle with detailed anatomical structures was achieved by using our modified Nagata method in which a stable and sophisticated framework can be fabricated with less cartilage requirement.
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Affiliation(s)
- Qiang Li
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan AQ4 District, 100144 Beijing, China
| | - Xu Zhou
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan AQ4 District, 100144 Beijing, China
| | - Yue Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan AQ4 District, 100144 Beijing, China
| | - Jin Qian
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan AQ4 District, 100144 Beijing, China
| | - Qingguo Zhang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan AQ4 District, 100144 Beijing, China.
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Crisan D, Schneider LA, Kastler S, Scharffetter-Kochanek K, Crisan M, Veit JA. Surgical management of skin cancer and trauma involving the middle third of the auricle. J Dtsch Dermatol Ges 2018; 16:694-701. [DOI: 10.1111/ddg.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Diana Crisan
- Department of Dermatology and Allergic Diseases; University Medical Center Ulm; Germany
| | | | - Sabine Kastler
- Department of Dermatology and Allergic Diseases; University Medical Center Ulm; Germany
| | | | - Maria Crisan
- Department of Dermatology; University of Medicine and Pharmacy “Iuliu Hatieganu”; Cluj-Napoca Romania
| | - Johannes Alexander Veit
- Department of Otorhinolaryngology; Head and Neck Surgery; University Medical Center Ulm; Germany
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Crisan D, Schneider LA, Kastler S, Scharffetter-Kochanek K, Crisan M, Veit JA. Chirurgische Versorgung von Hautkrebs und Trauma im mittleren Drittel der Ohrmuschel. J Dtsch Dermatol Ges 2018; 16:694-702. [DOI: 10.1111/ddg.13544_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Diana Crisan
- Department of Dermatology and Allergic Diseases (Klinik für Dermatologie und Allergologie); University Medical Center Ulm (Universitätsklinikum Ulm); Deutschland
| | - Lars Alexander Schneider
- Department of Dermatology and Dermatosurgery (Abteilung für Dermatologie und dermatologische Chirurgie); Helios Clinic (Helios Klinik); Rottweil Deutschland
| | - Sabine Kastler
- Department of Dermatology and Allergic Diseases (Klinik für Dermatologie und Allergologie); University Medical Center Ulm (Universitätsklinikum Ulm); Deutschland
| | - Karin Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases (Klinik für Dermatologie und Allergologie); University Medical Center Ulm (Universitätsklinikum Ulm); Deutschland
| | - Maria Crisan
- Department of Dermatology (Abteilung für Dermatologie); University of Medicine and Pharmacy „Iuliu Hatieganu“ (Universität für Medizin und Pharmazie „Iuliu Hatieganu“); Cluj-Napoca Rumänien
| | - Johannes Alexander Veit
- Department of Otorhinolaryngology; Head and Neck Surgery (Klinik für Hals-Nasen-Ohrenheilkunde; Kopf-Halschirurgie); University Medical Center Ulm (Universitätsklinikum Ulm); Deutschland
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Der C, Bravo-torres S, Pons N. Active Transcutaneous Bone Conduction Implant: Middle Fossa Placement Technique in Children With Bilateral Microtia and External Auditory Canal Atresia. Otol Neurotol 2018; 39:e342-8. [DOI: 10.1097/mao.0000000000001809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duisit J, Amiel H, Wüthrich T, Taddeo A, Dedriche A, Destoop V, Pardoen T, Bouzin C, Joris V, Magee D, Vögelin E, Harriman D, Dessy C, Orlando G, Behets C, Rieben R, Gianello P, Lengelé B. Perfusion-decellularization of human ear grafts enables ECM-based scaffolds for auricular vascularized composite tissue engineering. Acta Biomater 2018; 73:339-54. [PMID: 29654989 DOI: 10.1016/j.actbio.2018.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Human ear reconstruction is recognized as the emblematic enterprise in tissue engineering. Up to now, it has failed to reach human applications requiring appropriate tissue complexity along with an accessible vascular tree. We hereby propose a new method to process human auricles in order to provide a poorly immunogenic, complex and vascularized ear graft scaffold. METHODS 12 human ears with their vascular pedicles were procured. Perfusion-decellularization was applied using a SDS/polar solvent protocol. Cell and antigen removal was examined by histology and DNA was quantified. Preservation of the extracellular matrix (ECM) was assessed by conventional and 3D-histology, proteins and cytokines quantifications. Biocompatibility was assessed by implantation in rats for up to 60 days. Adipose-derived stem cells seeding was conducted on scaffold samples and with human aortic endothelial cells whole graft seeding in a perfusion-bioreactor. RESULTS Histology confirmed cell and antigen clearance. DNA reduction was 97.3%. ECM structure and composition were preserved. Implanted scaffolds were tolerated in vivo, with acceptable inflammation, remodeling, and anti-donor antibody formation. Seeding experiments demonstrated cell engraftment and viability. CONCLUSIONS Vascularized and complex auricular scaffolds can be obtained from human source to provide a platform for further functional auricular tissue engineered constructs, hence providing an ideal road to the vascularized composite tissue engineering approach. STATEMENT OF SIGNIFICANCE The ear is emblematic in the biofabrication of tissues and organs. Current regenerative medicine strategies, with matrix from donor tissues or 3D-printed, didn't reach any application for reconstruction, because critically missing a vascular tree for perfusion and transplantation. We previously described the production of vascularized and cell-compatible scaffolds, from porcine ear grafts. In this study, we ---- applied findings directly to human auricles harvested from postmortem donors, providing a perfusable matrix that retains the ear's original complexity and hosts new viable cells after seeding. This approach unlocks the ability to achieve an auricular tissue engineering approach, associated with possible clinical translation.
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Vercruysse H, Green JI, Osman G, Harrison B, Miyagi K, Bulstrode NW. Splinting After Ear Reconstruction: A Stepwise and Inexpensive Workflow Protocol. Ann Plast Surg 2018; 80:356-8. [PMID: 28930780 DOI: 10.1097/sap.0000000000001212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Long-term postoperative splinting plays a role in the prevention of contracture of the grafted skin after a second-stage ear reconstruction. The scar retraction could lead to an unfavorable aesthetic outcome. Splinting could play a role to overcome or prevent the loss of projection and the obliteration of the sulcus. MATERIAL AND METHODS We have defined the characteristics of an ideal long-term splint and present a stepwise clinical protocol for the fabrication of an ethylene-vinyl acetate splint. The splint was applied to all patients included in a prospective study on the postoperative splinting regime. Ethylene-vinyl acetate has proved its safety and longevity in dental prosthetics. CONCLUSIONS Patient compliance was optimal, and no allergic reactions, pressure sores, or skin necrosis were reported. The splint is self-retaining and light weight. Because of its transparent color, it can be easily camouflaged. A stepwise clinical protocol for the fabrication of a low-cost patient-specific ear splint is presented.
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Lingeshwar D, Appadurai R, Challa P, Sswedheni SU. Auricular Retentive Prosthetic Conformer Post Brent's Stage III Surgery in Microtia Repair: A Clinical Report. J Prosthodont 2018; 28:e817-e821. [PMID: 29508486 DOI: 10.1111/jopr.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/01/2022] Open
Abstract
Auricular reconstruction is an interdisciplinary approach where multiple specialties play a vital role in the treatment provided to the patient. This article provides a comprehensive interpretation of the process carried out for the fabrication of a custom-made prosthetic conformer for the management of postoperative contraction of a skin graft after ear reconstruction surgery-Brent stage III. The prosthesis is used as a precautionary measure and is simple, effective, and economical.
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Affiliation(s)
| | - R Appadurai
- Government Royapettah Hospital, Chennai, India
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Apelgren P, Amoroso M, Lindahl A, Brantsing C, Rotter N, Gatenholm P, Kölby L. Chondrocytes and stem cells in 3D-bioprinted structures create human cartilage in vivo. PLoS One 2017; 12:e0189428. [PMID: 29236765 PMCID: PMC5728520 DOI: 10.1371/journal.pone.0189428] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/25/2017] [Indexed: 12/21/2022] Open
Abstract
Cartilage repair and replacement is a major challenge in plastic reconstructive surgery. The development of a process capable of creating a patient-specific cartilage framework would be a major breakthrough. Here, we described methods for creating human cartilage in vivo and quantitatively assessing the proliferative capacity and cartilage-formation ability in mono- and co-cultures of human chondrocytes and human mesenchymal stem cells in a three-dimensional (3D)-bioprinted hydrogel scaffold. The 3D-bioprinted constructs (5 × 5 × 1.2 mm) were produced using nanofibrillated cellulose and alginate in combination with human chondrocytes and human mesenchymal stem cells using a 3D-extrusion bioprinter. Immediately following bioprinting, the constructs were implanted subcutaneously on the back of 48 nude mice and explanted after 30 and 60 days, respectively, for morphological and immunohistochemical examination. During explantation, the constructs were easy to handle, and the majority had retained their macroscopic grid appearance. Constructs consisting of human nasal chondrocytes showed good proliferation ability, with 17.2% of the surface areas covered with proliferating chondrocytes after 60 days. In constructs comprising a mixture of chondrocytes and stem cells, an additional proliferative effect was observed involving chondrocyte production of glycosaminoglycans and type 2 collagen. This clinically highly relevant study revealed 3D bioprinting as a promising technology for the creation of human cartilage.
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Affiliation(s)
- Peter Apelgren
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
- * E-mail:
| | - Matteo Amoroso
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Anders Lindahl
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Camilla Brantsing
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Nicole Rotter
- Department of Otorhinolaryngology, University Medical Centre Ulm, Ulm, Germany
| | - Paul Gatenholm
- 3D Bioprinting Centre, Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
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Mandelbaum RS, Volpicelli EJ, Martins DB, Park SH, Dubina E, Ishiyama A, Bradley JP, Lee JC. Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications. Plast Reconstr Surg Glob Open 2017; 5:e1460. [PMID: 29062641 DOI: 10.1097/GOX.0000000000001460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/06/2017] [Indexed: 11/26/2022]
Abstract
Background: In craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function. Methods: Craniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes. Results: In total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P < 0.001) and decreased aesthetic outcomes (P < 0.001) but not complications. In total, 87.1% of patients with microtia had documented hearing loss, of which the majority were conductive and 18.5% were mixed sensorineural and conductive. Hearing deficits were addressed in 70.4% of patients with external hearing aids, bone anchored hearing aids, or canaloplasty. Of all variables, improvement of psychosocial function was correlated only to hearing loss treatment of any type (P = 0.01). Conclusions: On evaluation of surgical and patient characteristics, severity of microtia predicted the total number of surgical revisions performed and aesthetic ratings. In addition, we found that the only factor that correlated with improved patient and parent-reported psychosocial outcomes was treatment of hearing loss.
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Chkadua TZ, Asirova GV, Mustafina FK, Chernenkiy MM, Frolov SS, Vejze DL. [Reconstructive otoplasty: differentiated approach to rib cartilage processing and ear framework formation using carving technique]. Stomatologiia (Mosk) 2017; 96:30-35. [PMID: 28617404 DOI: 10.17116/stomat201796330-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the research was to optimize surgical rehabilitation of patients with auricle defects and deformities by the developing of differentiated approach to the choice of reconstructive otoplasty method. The study involved 30 patients with auricle defects and deformities of congenital (20 patients) and acquired (10 patients) etiology. The defects were total in 25 patients and partial in 5 patients. All patients underwent ear reconstruction with rib cartilage using carving technique. Preoperative planning was based in Doppler ultrasound of temporal region vessels, laser Doppler flowmetry, temporal skin ultrasound and 3D ribcage CT. The surgical tactic was selected according to the possibility of mastoid region skin usage or necessity of the temporoparietal fascial flap. The approach proved to be highly efficient as otoplasty outcomes were good in 80% of cases, satisfactory in 10% and unsatisfactory in 10%.
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Affiliation(s)
- T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - G V Asirova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - F K Mustafina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M M Chernenkiy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - S S Frolov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - D L Vejze
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Abstract
Microtia reconstruction is a challenging endeavor that has seen significant technique evolution. It is important to educate patients and their families to determine the best hearing rehabilitation and ear reconstructive options. Microtia is often associated with aural atresia, hearing loss, and craniofacial syndromes. Optimal care is provided by multiple disciplines, including a reconstructive surgeon, an otologic surgeon, an audiologist, and a craniofacial pediatrician. Microtia management includes observation, prosthetic ear, autologous cartilage reconstruction, or alloplastic implant placement. Hearing management options are observation, bone conduction sound processor, or atresiaplasty with and without hearing aids. Appropriate counseling should be done to manage expectations.
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Affiliation(s)
- Randall A Bly
- Pediatric Otolaryngology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Amit D Bhrany
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 Pacific Avenue NE, Seattle, WA 98195, USA
| | - Craig S Murakami
- Division of Otolaryngology Head and Neck Surgery, Virginia Mason Medical Center, University of Washington, 1201 Terry Avenue, Seattle, WA 98101, USA
| | - Kathleen C Y Sie
- Childhood Communication Center, Richard and Francine Loeb Endowed Chair in Childhood Communication Research, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Ha JF, Morrison RJ, Green GE, Zopf DA. Computer-Aided Design and 3-Dimensional Printing for Costal Cartilage Simulation of Airway Graft Carving. Otolaryngol Head Neck Surg 2017; 156:1044-1047. [PMID: 28397538 DOI: 10.1177/0194599817697048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Autologous cartilage grafting during open airway reconstruction is a complex skill instrumental to the success of the operation. Most trainees lack adequate opportunities to develop proficiency in this skill. We hypothesized that 3-dimensional (3D) printing and computer-aided design can be used to create a high-fidelity simulator for developing skills carving costal cartilage grafts for airway reconstruction. The rapid manufacturing and low cost of the simulator allow deployment in locations lacking expert instructors or cadaveric dissection, such as medical missions and Third World countries. In this blinded, prospective observational study, resident trainees completed a physical simulator exercise using a 3D-printed costal cartilage grafting tool. Participant assessment was performed using a Likert scale questionnaire, and airway grafts were assessed by a blinded expert surgeon. Most participants found this to be a very relevant training tool and highly rated the level of realism of the simulation tool.
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Affiliation(s)
- Jennifer F Ha
- 1 Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- 2 Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Glenn E Green
- 1 Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Zopf
- 1 Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.,3 Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Li G, Zhang F, Ding W, Wu Z, Hu Y, Luo T, Zhang B, Jiang X. A New Microtia Reconstruction Method Using Delayed Postauricular Skin Flap: . Plast Reconstr Surg 2017; 139:946-55. [DOI: 10.1097/prs.0000000000003227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akter F, Mennie JC, Stewart K, Bulstrode N. Patient reported outcome measures in microtia surgery. J Plast Reconstr Aesthet Surg 2017; 70:416-424. [DOI: 10.1016/j.bjps.2016.10.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 11/16/2022]
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Möller T, Amoroso M, Hägg D, Brantsing C, Rotter N, Apelgren P, Lindahl A, Kölby L, Gatenholm P. In Vivo Chondrogenesis in 3D Bioprinted Human Cell-laden Hydrogel Constructs. Plast Reconstr Surg Glob Open 2017; 5:e1227. [PMID: 28280669 DOI: 10.1097/GOX.0000000000001227] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/19/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The three-dimensional (3D) bioprinting technology allows creation of 3D constructs in a layer-by-layer fashion utilizing biologically relevant materials such as biopolymers and cells. The aim of this study is to investigate the use of 3D bioprinting in a clinically relevant setting to evaluate the potential of this technique for in vivo chondrogenesis. METHODS Thirty-six nude mice (Balb-C, female) received a 5- × 5- × 1-mm piece of bioprinted cell-laden nanofibrillated cellulose/alginate construct in a subcutaneous pocket. Four groups of printed constructs were used: (1) human (male) nasal chondrocytes (hNCs), (2) human (female) bone marrow-derived mesenchymal stem cells (hBMSCs), (3) coculture of hNCs and hBMSCs in a 20/80 ratio, and (4) Cell-free scaffolds (blank). After 14, 30, and 60 days, the scaffolds were harvested for histological, immunohistochemical, and mechanical analysis. RESULTS The constructs had good mechanical properties and keep their structural integrity after 60 days of implantation. For both the hNC constructs and the cocultured constructs, a gradual increase of glycosaminoglycan production and hNC proliferation was observed. However, the cocultured group showed a more pronounced cell proliferation and enhanced deposition of human collagen II demonstrated by immunohistochemical analysis. CONCLUSIONS In vivo chondrogenesis in a 3D bioprinted human cell-laden hydrogel construct has been demonstrated. The trophic role of the hBMSCs in stimulating hNC proliferation and matrix deposition in the coculture group suggests the potential of 3D bioprinting of human cartilage for future application in reconstructive surgery.
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Li Y, Zhang R, Zhang Q, Xu Z, Xu F, Li D. An Alternative Posterosuperior Auricular Fascia Flap for Ear Elevation During Microtia Reconstruction. Aesthetic Plast Surg 2017; 41:47-55. [PMID: 28032165 DOI: 10.1007/s00266-016-0743-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advances in staged total auricular reconstruction have resulted in improved anterior auricular appearance; however, satisfactory postreconstruction esthetics of the retroauricular fold remain challenging. The postauricular appearance of the reconstructed ear depends largely upon optimizing the covering material. When used as the covering soft tissue for ear elevation, a flap containing primarily the upper portion of the retroauricular fascia has potential advantages over the conventional book cover-type retroauricular fascia flap. METHODS We developed a geometrically designed, posterosuperior auricular fascia flap to replace the conventional retroauricular fascia flap for ear elevation. During the second-stage operation, the posterosuperior auricular fascia flap is rotated downward and turned over to wrap around the inner strut and entire posterior auricular surface. RESULTS Compared to the conventional book cover-type retroauricular fascia flap, the novel posterosuperior auricular fascia flap was easier to harvest and the operative time significantly decreased (110.3 vs. 121.5 min, p < 0.01). The modified flap produced a thin and natural contour of the postauricular surface, as well as reduced the incidence of postauricular hypertrophic scarring (from 24.7 to 13.2%, p = 0.03) and partial skin graft necrosis (from 43.4 to 31.2%, p = 0.01). CONCLUSION The geometrically designed posterosuperior auricular fascia flap improves ear elevation. Compared to the conventional book cover-type retroauricular fascia flap, this covering tissue is easier to perform so the surgical time is decreased. It was highly vascularized, well defined, thinner, and yields reliable results. Thus, favorable postauricular surface results can be achieved during auricular reconstruction by using the modified fascia flap. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
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