Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zhenyu , LIU Ruiqi , WANG Ru , TANG Jun , LIU Chuanqi , CHEN Xinghan , CEN Ying ,  LI Zhengyong

Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

LI Zhengyong, Email: lizydd@sina.com

Keywords：

Microtia; auricular reconstruction; cartilage scaffold; mechanical equilibrium

DOI：

10.7507/1002-1892.201807137

Video：

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Objective To summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction.Methods Between June 2015 and June 2017, ninety-seven microtia patients (102 ears) were treated with total ear reconstruction by using tissue expanders. The patients included 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 8 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which were covered by enlarged flap. According to the three-dimensional mechanical equilibrium concept, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation.Results All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period.Conclusion Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.

Citation： ZHANG Zhenyu, LIU Ruiqi, WANG Ru, TANG Jun, LIU Chuanqi, CHEN Xinghan, CEN Ying, LI Zhengyong. Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 332-336. doi: 10.7507/1002-1892.201807137 Copy

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11.	Federspil PA. Auricular prostheses in microtia. Facial Plast Surg Clin North Am, 2018, 26(1): 97-104.
12.	Olshinka A, Louis M, Truong TA. Autologous ear reconstruction. Semin Plast Surg, 2017, 31(3): 146-151.
13.	Patel SA, Bhrany AD, Murakami CS, et al. Autologous costochondral microtia reconstruction. Facial Plast Surg, 2016, 32(2): 188-198.
14.	Cabin JA, Bassiri-Tehrani M, Sclafani AP, et al. Microtia reconstruction: autologous rib and alloplast techniques. Facial Plast Surg Clin North Am, 2014, 22(4): 623-638.
15.	孫恒赟, 趙延勇, 蔣海越, 等. 肋軟骨支架耳廓再造術后感染的治療和預后分析. 中華整形外科雜志, 2017, 33(3): 171-174.
16.	王美水, 王彪, 單秀英, 等. 刃厚頭皮片和顳頂筋膜瓣在低發際小耳耳廓再造中的應用. 中國修復重建外科雜志, 2016, 30(2): 208-210.
17.	齊一蘭, 李正勇, 岑瑛, 等. 顳淺動脈筋膜瓣聯合皮片修復全耳再造術后耳軟骨支架外露. 中國修復重建外科雜志, 2016, 30(5): 655-656.
18.	郭佩佩, 蔣海越. 獲得性耳廓缺損的外科治療進展. 中國修復重建外科雜志, 2018, 32(9): 1218-1222.
19.	Wu R, Jiang H, Chen W, et al. Three-dimensional chest computed tomography analysis of thoracic deformities in patients with microtia. J Plast Reconstr Aesthet Surg, 2015, 68(4): 498-504.
20.	Yang HC, Cho HH, Jo SY, et al. Donor-site morbidity following minimally invasive costal cartilage harvest technique. Clin Exp Otorhinolaryngol, 2015, 8(1): 13-19.

1. Wilkes GH, Wong J, Guilfoyle R. Microtia reconstruction. Plast Reconstr Surg, 2014, 134(3): 464e-479e.
2. Bly RA, Bhrany AD, Murakami CS, et al. Microtia reconstruction. Facial Plast Surg Clin North Am, 2016, 24(4): 577-591.
3. 王美水, 王彪, 鄭厚兵, 等. 二期法耳廓再造術治療耳垂型小耳畸形的臨床療效. 中國修復重建外科雜志, 2011, 25(12): 1473-1476.
4. Zhang M, Tian X, Shi J, et al. Investigation of microsurgical technique combined with skin flap expansion for ear reconstruction in treating hunter type Ⅲ congenital microtia. Ann Plast Surg, 2017, 78(6): 680-683.
5. 楊錦秀, 何樂人. Klippel-Feil綜合征合并耳畸形的研究進展. 中國修復重建外科雜志, 2015, 29(11): 1434-1440.
6. 何樂人, 張晉光, 蔣海越, 等. 合并顱面畸形的小耳畸形耳廓再造術. 中國修復重建外科雜志, 2012, 26(12): 1477-1481.
7. 蔣海越, 潘博, 林琳. 先天性小耳畸形的分型及治療策略. 中華耳科雜志, 2013, 11(4): 476-480.
8. Im DD, Paskhover B, Staffenberg DA, et al. Current management of microtia: a national survey. Aesthetic Plast Surg, 2013, 37(2): 402-408.
9. 張如鴻. 先天性小耳畸形患者耳廓再造的美學重建研究. 中華耳鼻咽喉頭頸外科雜志, 2015, 50(3): 187-191.
10. Bonilla A. Pediatric microtia reconstruction with autologous rib: personal experience and technique with 1000 pediatric patients with microtia. Facial Plast Surg Clin North Am, 2018, 26(1): 57-68.
11. Federspil PA. Auricular prostheses in microtia. Facial Plast Surg Clin North Am, 2018, 26(1): 97-104.
12. Olshinka A, Louis M, Truong TA. Autologous ear reconstruction. Semin Plast Surg, 2017, 31(3): 146-151.
13. Patel SA, Bhrany AD, Murakami CS, et al. Autologous costochondral microtia reconstruction. Facial Plast Surg, 2016, 32(2): 188-198.
14. Cabin JA, Bassiri-Tehrani M, Sclafani AP, et al. Microtia reconstruction: autologous rib and alloplast techniques. Facial Plast Surg Clin North Am, 2014, 22(4): 623-638.
15. 孫恒赟, 趙延勇, 蔣海越, 等. 肋軟骨支架耳廓再造術后感染的治療和預后分析. 中華整形外科雜志, 2017, 33(3): 171-174.
16. 王美水, 王彪, 單秀英, 等. 刃厚頭皮片和顳頂筋膜瓣在低發際小耳耳廓再造中的應用. 中國修復重建外科雜志, 2016, 30(2): 208-210.
17. 齊一蘭, 李正勇, 岑瑛, 等. 顳淺動脈筋膜瓣聯合皮片修復全耳再造術后耳軟骨支架外露. 中國修復重建外科雜志, 2016, 30(5): 655-656.
18. 郭佩佩, 蔣海越. 獲得性耳廓缺損的外科治療進展. 中國修復重建外科雜志, 2018, 32(9): 1218-1222.
19. Wu R, Jiang H, Chen W, et al. Three-dimensional chest computed tomography analysis of thoracic deformities in patients with microtia. J Plast Reconstr Aesthet Surg, 2015, 68(4): 498-504.
20. Yang HC, Cho HH, Jo SY, et al. Donor-site morbidity following minimally invasive costal cartilage harvest technique. Clin Exp Otorhinolaryngol, 2015, 8(1): 13-19.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction

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