Clinical Research Of Auricular Reconstruction In Hemifacial Microsomia

Objective:The purpose of this study is to research the clinical application of expanded two-flap method auricular reconstruction in patients with hemifacial microsomia, providing optimization auricular reconstruction technique for microtia patients with hemifacial microsomia.Methods:From January 2014 to November 2015,111 microtia patients with moderate and severe hemifacial microsomia were treated in our department. Of the 111 patients in this series,58 were right,53 were left. A total of 87 of the patients were male, and 24 were female, ranging in age from 5 to 27 years with an average of 9.2 years. The patients were treated by expanded two-flap method which includes three stages. In the first stage, the 50 ml kidney-shape tissue expander was implanted in the retroauricular mastoid region subcutaneously. In the second stage, the costal cartilage was harvested and the framework was fabricated. After the expander was removed, the framework was enveloped by the expanded two-flap, In the third stage, tragus was formed, lobule was transposed and the concha was excavated.Results:The 111 patients were followed up for 5 to 20 months (in average 8.3 months) postoperative.103 (92.8%) patients were satisfied with the operation, the size, position and auriculocephalic sulcus of the reconstructed ear are similar to the normal ear with the clear and harmonious substructure, and there were no serious complications. However,7 patients were basically satisfactory,1 patient was not satisfied with the result. There were 9 complications in this series. Complications related to tissue expander implantation:2 cases with hematoma, the expander were removed and hemostasis performed in the operating room; 1 case with infection, the infection was controlled by repeated washing the cavity with 2% Iodine Tincture and alcohol. Partial necrosis of the expanded flap occurred in 2 patients, the necrosis were located on the superior part of the expanded flap and Local infection did not exist in them. They were operated with Brent method in advance and obtained good results. Leakage of expander was occurred in 1 case with the expander changed. Complications in the second stage:1 case with necrosis of the post-auricular skin graft healed after dressing change regularly; 0 case of framework infection; 2 cases of the exposure of cartilage framework,1 was located on the anterior part of the lobule and treated by local flap,1 was located on the up 1/3 of the helix and treated with temporoparietal fascial flap and free skin graft.Conclusion:Non-hair bearing, thin, well-vascularized skin can formed by the expanded two-flap ear reconstruction method which was suitable for microtia patients with hemifacial microsomia who are characterized by tight skin, thin post-auricular fascial and bad blood circulation. Low hairline was managed by laser hair removal, and the area of non-hair bearing was increased. The temporal bone of most patients were dysplasia, to compensate the depressed temporal bone the height of the framework should enhanced. Lobule transposition, Lobule transposition combined with V-Y-advance or Z-plasty and retrograde lobule transposition were used in forming the earlobe. The expanded two-flap method is an effective auricular reconstruction technique in microtia patients with hemifacial microsomia.