| Background:Congenital microtia,a congenital abnormality in the development of the auricle,is the second largest craniofacial deformity after cleft lip and palate deformity,the morbidity in China is about 0.03%.Nagata divides microtia into four types:lobule-type,conchae-type,microconchae-type and anotia-type,among which,lobule-type microtia is the most common type.The vestibule of patients with lobule-type has only a small skin tag,or a small amount of helix cartilage,and the absence of important subunit structures such as auricula concha and tragus,and the absence of skin.In modern society,people’s aesthetic standards are getting higher and higher,and the aesthetic requirements for reconstruction of auricle shape are also improved.The result of a good reconstruction of the auricle largely depends on the carving of the auricle bracket and the quality and quantity of the skin covering the bracket.Many clinical scholars have put forward different surgical schemes according to their clinical experience and achieved corresponding effects,but there are still some shortcomings after surgery,and the aesthetic effect of reconstruction of the auricle still needs to be improved,and there is still no unified optimal scheme.Clinically,we found that for patients with lobule-type microtia,under the premise of three-dimensional engraving of the auricle bracket,the skin covering the bracket was often insufficient.The reconstructed concha cavum is shallow and lacks three-dimensional sense,thus affecting the aesthetic effect of the reconstructed auricules.How to solve this problem is very urgent.Objective:Compared and analyzed the reconstruction effect of the reconstruction of the auricle shape,especially the concha cavum and tragus after the application of the transfer of the subcutaneous pedicle island flap in the posterior mastoid region and the traditional non-transfer of the poetsrior mastoid region flap in auricle reconstruction of patients with lobule-type microtia,to investigate the effect of transferring the subcutaneous pedicle island flap in the posterior mastoid region on the reconstruction of concha cavum and tragus and the enhancement of the reconstruction of auricle in patients with lobule-type microtia.To seek an optimal scheme for auricle reconstruction in patients with lobule-type microtia.Methods:Clinical data of patients with congenital earlobe microtia who underwent secondary auricle reconstruction were collected from June 2018 to January 2023 in the Plastic Surgery Department of Henan Provincial People’s Hospital.The primary operation was divided into study group and control group according to different operation methods.A total of 78 patients conforming to the criteria were included,including 35 in the study group and 43 in the control group.In the study group,there were 22 males and 13 females,ranging in age from 6 to 18 years,with an average age of 11.49 years.In the control group,there were 32 males and 11 females,ranging in age from 6 to 18 years old with an average age of 11.05 years old.There were no significant differences in gender and age distribution between the two groups(P>0.05).Modified Nagata auricle reconstruction was performed in the first stage,and the surgical design was slightly different between the study group and the control group.Study group:A subcutaneous pedicle island flap was formed in the posterior and lower mastoid region of the earlobe to cover the wounds caused by insufficient skin in the auricula concha and tragus.Control group:according to the traditional Nagata method;Rotate the earlobe and shape the auricle.The blood circulation of the transferred flap was obsenved after operation.The second stage was an otocranioplasty.The two groups were operated in the same way:the auricle bracket was lifted,and the remaining costal cartilage buried during the first-stage operation was canved to form a support bracket behind the ear.For patients with insufficient cartilage,the remaining costal cartilage buried in the first-stage operation was used to make cartilage slices,which were pasted on the dorsal side of the Medpor bracket,so as to form a cartilage-Medpor composite scaffold to support the raised auricle.The posterior ear wound was covered with an expanded posterior ear fascia flap,and the surface of the fascia flap was grafted with free skin.Follow-up was conducted 3 to 12 months after the first and second stage,and the reconstruction effect of concha cavum and tragus as well as the shape of the reconstructed auricle were evaluated in the two groups.The blood flow of the transferred flap and the incision scar in the donor flap area were observed.The scar recovery in the donor area of skin flap was scored with the scar beauty rating scale.Results:78 cases were followed up after the first stage,including 35 cases in the study group(22 males and 13 females)and 43 cases in the control group(32 males and 11 females).Fifty-one patients were followed up after the second stage,including 20 in the study group(13 males and 7 females)and 31 in the control group(22 males and 9 females).1.In the study group,34 patients with the transferred flap had good blood circulation after the first stage surgery,and only 1 patient showed venous congestion of the flap,which improved spontaneously 5 days after the surgery,and the incision healed in the first stage.2.Evaluation of the effect of first-stage postoperative reconstruction of concha cavum and tragus reconstruction:in the study group,the results were excellent in 29 cases and poor in 6 cases,with an excellent rate of 82.3%;In the control group,24 cases were excellent,19 cases were poor,and the rate of excellent was 55.8%.The difference between the two groups was statistically significant(χ2=6.479,P=0.011,P<0.05).3.Evaluation of the shape of the reconstructed ear after the first stage surgery:in the study group,34 cases were excellent,1 case was poor,and the excellent rate was 97.1%.In the control group,33 cases were excellent,10 cases were poor,and the excellent rate was 76.7%.There was a statistical difference between the two groups(χ2=5.051,P=0.025,P<0.05).4.In the study group,the satisfaction rate of scar incision in the donor area of the skin flap was 91.4%(32/35),indicating high satisfaction.5.Evaluation of the effect of second-stage reconstruction of concha cavum and tragus:in the study group,the results were excellent in 18 cases,poor in 2 cases,and the excellent rate was 90.0%.In the control group,17 cases were excellent,14 cases were poor,and the rate of excellent was 54.8%.The difference between the two groups was statistically significant(χ2=6.981,P=0.008,P<0.05).6.Evaluation of the shape of the reconstructed ear after the second stage surgery:in the study group,19 cases were excellent,1 case was poor,and the excellent rate was 95.0%.In the control group,18 cases were excellent,13 cases were poor,and the rate of excellent was 58.1%.There was a statistical difference between the two groups(χ2=8.328,P=0.004,P<0.05).7.In the study group,the scar satisfaction rate was 95.0%(19/20),with high satisfaction.Conclusion:1.The transfer of the subcutaneous pedicle flap in the posterior mastoid region significantly enhanced the reconstruction of the concha cavum and the reconstruction of concha cavum and tragus in patients with lobule-type microtia;2.The transfer of the subcutaneous pedicle flap in the posterior mastoid region of the ear made the overall appearance of the reconstructed auricle more three-dimensional and improved the aesthetic effect of the reconstructed auricle;3.The incision scar in the donor area of the skin flap with the transfer of subcutaneous pedicle flap in the retroauricular mastoid region was not obvious,which was acceptable to most patients and their families;4.The transfer subcutaneous flap technique in the retroauricular mastoid area has significant advantages in the auricular reconstruction of patients with congenital microtia of the lobule-type,and provides a more optimal solution for the auricular reconstruction of patients with microtia of the lobule-type,which has clinical application value and is worth promoting. |
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