The Clinical Study Of Auricular Reconstruction Using The Technique Of Soft Tissue Expansion

objective The aim of the study is to research the clinical application of the technique of soft tissue expansion in auricular reconstruction, evaluate and discuss the postoperative results, and hope to provide therapies more superior for patients with auricular defects.Methods From August2011to January2014, a total of544patients aged5to44years old were included in the study. According to the condition of retroauricular soft tissue of the patients,459cases accepted the "two-flap" technique in ear reconstruction, while other85cases accepted the "single-flap" technique. Auricular reconstruction was performed in three surgical stages. In the first stage, a50-ml or80-ml expander was inserted in the retroauricular mastoid region. In the second stage, after the expander was removed, the autogenous costal cartilage was harvested and framework was sculptured. The cartilage framework was then wrapped by the expanded skin flap (the "single-flap" technique)only or expanded retroauricular skin flap combined with retroauricular fascial flap(the "two-flap" technique). Tragus construction, lobule transposition and conchal excavation was performed in the third stage.Results All patients were followed up for1to29months after operation,511patients were satisfied with the appearance of good shape, accurate size, right position and orientation, symmetric auriculocephalic angle, stable structure of reconstructed helix, scapha, antihelix, triangular fossa, tragus, auricular concha, and no serious complication. Postoperative complications occurred in44cases in our group.6cases with hematoma, their expanders were taken out and re-implanted after hemostasis.1case with disruption of wound, who healed after debridement and suture.5cases with leakage of expander, the expander were changed.14cases who operated in advance with ulceration of expanded skin flap.2cases had infection after the expander implantation, their expanders were taken out.8cases with exposure of cartilage framework,4of them healed after dressing,1case was treated with local flap,3cases were treated with temporoparietal fascial flap.4cases had postoperative infection,3of them healed after dressing and drainage, other1case whose framework were removed finally. Conclusions The prominent advantage of the technique of soft tissue expansion is to provide abundant and thin skin, which is especially appropriate for the patients who have retroauricular skin thick, tight and small, low hairline, or retroauricular soft tissue damaged from trauma or operation. Moreover, the expanded skin flap is more tolerant for necrosis. Ear reconstruction with the "single-flap" technique is a ideal method to treat auricular defects only by covering cartilage framework with expanded skin flap, obtaining erect reconstructed auricle with fine structure, without skin grafting and fascial flap. And advantages of the technique are simple operation, little trauma, less complication. In addition, it provide a method for patients with retroauricular soft tissue damaged severely. Therefore, we consider auricular reconstruction using the technique of soft tissue expansion is a ideal and reliable treatment for patients with ear defects.