Comparison of auricle reconstruction with expanded flaps and auricle reconstruction with non-expanded flaps in patients with microtia: A meta-analysis

Objective We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 3.2% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 2.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 3.1% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis ( P > .05). Conclusion The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.

Application of Multislice Spiral CT Volume Reconstruction in Congenital Microtia Reconstruction

Objective. To investigate the application of multislice spiral CT in volume reconstruction of congenital microtia. Methods. Sixty patients who underwent auricle reconstruction in Otolaryngology Hospital of our hospital from April 2020 to April 2021 were selected. All patients had no mental disorders and normal cognitive ability and volunteered to participate in this study. Multislice spiral CT was used to evaluate the diagnostic accuracy of multislice spiral CT by scanning the morphology of the ossicular chain and the bone destruction of the selected patients. Results. MSCT can clearly display the structure of ear. Conclusion. MSCT can clearly reflect the external ear and the structure of the ear in patients with congenital microtia and distinguish the different types of patients obviously. Multiplane reconstruction and volume reconstruction can clearly display the fine structure of the patient’s ear, which has important reference value for surgery.

Long-term hearing performance and soft tissue outcomes of Baha@ Attract system in patients with bilateral congenital microtia in a single center

Abstract： Background: Baha Attract System was designed as non-skin penetrating bone conduction implant to minimize skin complication. However, there were insufficient studies on its long-time acoustic outcome and safety in microtia patients with auricle reconstruction surgeries, who have thinner retroauricular subcutaneous layer and theoretically vulnerable skin at the implant side. Objectives: To analysis the long-term hearing performance and soft tissue complications of Baha@ Attract System in microtia population. Study Design & setting: A prospective cohort study at single tertiary referral center. Patients: Twenty Mandarin-speaking patients with congenital bilateral microtia who were underwent Baha@ Attract implantation with or without auricle reconstruction surgeries simultaneously. Main Outcome Measure(s): Comparative analysis of audiological test results including hearing thresholds and speech recognition in quiet and in noise were pre- and post-operatively performed. subjective benefit as measured with the SSQ Scale. Soft tissue outcomes were monitored and documented. Results: The mean follow-up time was 36.11±3.30 months. Significant and stable improvements in hearing threshold and speech understanding in noise and quiet were demonstrated with aided condition. Subject evaluation revealed high level of patients’ satisfaction with the amplification in all the subscales. Adverse events including skin necrosis increased after one year post-operatively. Soft tissue evolution including sin thinning, erythema, epidermis atrophy, soft tissue atrophy, skin necrosis was seen or once developed in most of the participants. However, prevalence of severe soft tissue complication was not higher to non-microtia population. Conclusions: Baha@ Attract System provides favorable and stable hearing improvements for microtia patients. Combining plastic surgeries with implantation will not increase the prevalence of soft tissue complication. However, long-term soft tissue problems should be highly aware of even after one year post implantation. Key words: Baha Attract, microtia, hearing, soft tissue, skin necrosis

Management Strategy of Local Subcutaneous Effusion After Auricle Reconstruction

Objectives: Microtia is a severe congenital malformation of the external ear, and auricular reconstruction is still a challenge for plastic surgeons because of the complicated procedures and rare conditions. This study aimed to describe the location of subcutaneous effusion after auricular reconstruction and explore the clinical efficacy of the indwelling needle puncture drainage method in the treatment of local subcutaneous effusion. Methods: From January 2017 to December 2019, 1240 patients (1296 affected sides) who underwent auricular reconstruction using autogenous cartilage framework in the Plastic Surgery Hospital of Chinese Academy of Medical Science and Peking Union Medical College were selected. The local subcutaneous effusion occurred within 5 days after the drainage tube was removed, and the indwelling needle was used for puncture and drainage in the postoperative treatment. Results: A total of 55 patients had subcutaneous effusion after the operation, including 24 cases with Nagata’s method and 31 cases with the expanded single-flap method. One patient showed no obvious reduction after puncture and drainage by indwelling needle and improved after the secondary operation. Two patients had slight cartilage absorption. The remaining patients had good results. Conclusions: The method of the indwelling needle for puncture and drainage is easy to operate. The problem of local subcutaneous effusion after auricular reconstruction can be solved and good efficacy can be obtained.

Functional Respiratory Changes in Patients with Chest Wall Deformities Secondary to Autologous Costal Cartilage Harvest for Auricle Reconstruction

Background: The gold standard for auricle reconstruction is currently performed with autologous costal cartilage. This process is done at about nine years of age, but it leads to thoracic deformity, reported in up to 70% of the patients using aComputed Tomography (CT) scanner. Objective: The present study aims to determine if this deformity has functional implications for the patients. Methods: 54 patients were clinically evaluated and subjected to spirometry at least one year after the surgery. Results: Four cases had moderate pulmonary restriction, while seven had mild lung restriction. A total of 20.3% of the patients showed pulmonary restriction. The new results are particularly crucial for patients with preoperative (pre-op) ventilatory disease. Conclusion: In patients with thoracic deformity diagnosed by clinic exploration, spirometric abnormalities occur in up to 20.3%; when stratifying the risk by gender, the risk is only significant for women older than 15 years old.