Clinical Research Of Total Auricular Reconstruction With Autogenous Costal Cartilages Transplantation

Objective :To explore the therapeutic effects of two-stage otoplasty in the treatment of congenital microtia according to the specific circumstances of the congenital microtia patients and summarize the clinical experience in the past three years. Do the clinical evaluation according to the patients’ follow-up results, in order to evaluate the surgical method is worth clinical promotion.methods: The operation could be completed in two-stages. The first stage was to reconstruct an ear with normal anatomy including the costal cartilage transplantation, separate and remove the remnant cartilage. The detailed operations were as follows: designing and incising a N-shaped pattern on the defective auricle, separating and removing the remnant cartilage, undermining a proper space according to the size of the template(the stripping level is subcutaneous dissection), keeping a subcutaneous pedicle as wide as possible to ensure the blood supply of the flap, cuting and removing the No.6、7、8 heterolateral costal cartilage of the defective auricle and sculpture them into an auricle framework, noting the auricle’s morphological structure, mbedding the framework into the mastoid region, transferring the remnant lobe to link to the inferior framework. The second stage operation could be implemented at least 6 months after the first stage finished, including setting off the outer part of the ear, reconstructing the cranial angular, taking out the remnant costal cartilage or the Medpor biological material to form a semi arc upholder of 2cm×1cm×1.5cm. Make a skin incision away from the outer edge of the reconstructed ear about 0.5cm, set off the outer part of the reconstructed auricle at the level of mastoid region fascia, fix the upholder under the reconstructed auricle with silk suture No.1-0, keep the cranial angular steady at about 30°, use suitable mastoid region fascia flap cover the upholder, free grafting a full thick skin graft to cover the opisthotic wounds. Through the postoperative follow-up of structure, size, cranial auricular angle, symmetry, stability, and the satisfaction degree of patients, to asses the value of the operation.Results: From September 2011 to September 2014, a total of 128 congenital microtia patients(134 ears) have accepted the two-stage operation. The oldest patient is 38 years old, the youngest patient is 4 years old, the average age of all patients is 12.8 years. After the first stage operation, four of the patients(4ears) had partial skin flap necrosis without infection or cartilage problem, three of them were cured by dressing changed, one of them was cured by local skin flap transferred, other 124patients(130ears) resumed smoothly. Three cases of skin flap partly necrosis, one of them was cured by local skin flap transferred, the other were cured by dressing changed after the second stage operation. After the two-stage operation finished 6 to 24 months, 81patients(84ears) were follow-up successfully, their size and site of the reconstructed auricle were close to the normal ear; More than 7 anatomical structure of the reconstructed auricle can be distinguished clearly; the temperature, color, feeling and thickness of the mastoid region skin is normal. The reconstructed auricle can support pressure of daily life.Conclusions: Summarizing our clinical experiences of 128 congenital microtia patients from September 2012 to September 2014, the two-stage operation of congenital microtia have many advantages,such as shorter operation time, simple operation surgical, excellent surgical effect,less complications and so on, the effect of the operation is not very difference, so it’s worth of being generalized.