Clinical Research With Improved Nagata’s Techniques Combined With Autogenous Costal Cartilages Intotal Auricular Reconstruction

ObjectiveBased on better understanding of the anatomy of postauricular fascia as well as exploring the application of the biological material in the ear reconstruction, to look for a good appearing, safe, simple and optimal method for total auricular reconstructionMethodsClinical Research was divided into two-stage operation, in the first stage, including autogenous costal cartilage harvest and carve auricle forming, mastoid flap and the auricular framework entrapped, earlier ectopic lobe of transposition and cohesion, the remnant ear cartilage removed were performed; in the second stage:line of cranial angular reconstruction, including the outer part of the ear off, support cartilage or biological material filling, postauricular fascia covering, skin graft, late ear bracket fixing were accomplished. The interval time of two-stage operation is from3to6months.Phase Ⅰ:Generally6,7,8costal cartilages of the right side of breast were cut. Attention to changes in the auricle of the outer edge of the curve. Mastoid flap preserves the subdermal vascular network, retaining a subcutaneous pedicle in the distal of mastoid flap, the size should not hinder the ear frames smoothly rotating placement as the standard, the width is as large as possible, ensure good blood supply to the distal part of the flap.Phase Ⅱ:Pre-set autologous costal cartilage or silicon rubber in Phase I operation was shaped to form a willow wedge of5.5-6.5cm X1.0-1.5cm×1.0cm, embedded auriculocephalic angle,to keep the auriculocephalic angle about35degrees or2.0cm distance of mastoid to helix rim(preoperative reference to health ear). Postauricular fascia in the deep surface of the auriculocephalic angle vertical take the shape of the ear artery pedicle,up and down more than support bracket1.0cm,1.5～2.5cm extending to the ear, the top in the periosteum shallow, ends in the sternocleidomastoid muscle shallow to sharp dissection, to the support bracket edge. Support bracket was packaged by fascia flap without tention completely. Skin grafts were on the back of the pinna partition. Wearing stereotypical ear stent three months after taking out stitches to maintain good auriculocephalic angle.ResultsThirty Nine cases (41ears) have been performed clinically using improved Nagata’s techniques and all of them achieved satisfactory efficacies. All patients were followed up from six months to four years, the reforged ears looked natural and achieved superior cosmesis, and none of them experienced ear rim fracture or implant exposure or distortion.conclusion1.The mastoid flap embedded cartilage frames requires not only tissue flap is thin, but also has a good blood supply. Mastoid flap preserves the subdermal vascular network, retaining a subcutaneous pedicle in the distal of mastoid flap, the size should not hinder the ear frames smoothly rotating placement as the standard, the width is as large as possible, ensure good blood supply to the distal part of the flap.2.The wedge shaped cartilage implanted in the ear elevation replaces the Nagata,s crescent-shaped cartilage, not only more in line with anatomical features of cranioauricular angle, but not easily shifting, or even inversion.3. Postauricular fascia peridiumed postauricular costal cartilage or silicone frames, replacing temporoparietal fascial flap in the Nagata,s methods, can be similar with the cranioauricular angle at the normal side postoperatively. Postauricular fascia has a blood supply. Most of phase Ⅱ operation can be performed under local anesthesia with no additional scar. Temporoparietal fascial flap is more elaborate, vascular to some uncertainty with scar or alopecia left in the temporal. Temporoparietal fascial flap should be the second choice in the trauma of the reconstructed ear or to repair again.4.Autogenous costal cartilage as ear frames is the first choice currently with most common and safe. Biological material such as silicone rubber, hydroxyapatite combined with autogenous costal cartilage in the ear elevation, can not only reduce the amount of cartilage cutting in Phase Ⅰ operation, but support the ear effectively because of the silicon toughness. It provides a new idea to the auricular reconstruction.5.39cases(41ears) were reconstructed by the above improved Nagata’s techniques. After six months to four years of follow-up, appearance, size, symmetry are more satisfied appeared. There were no other complications and no thoracic deformity cases. It’s worthy of clinic application.