Effect Of Comprehensive Improvement Technique On Donor Site Of Thoracic Costal Cartilage In Total Auricle Reconstruction

Objective:To Explore the advantages of the improved technique,This study compared and analyzed the effect of comprehensive improvement technique and traditional technique on the donor site of thoracic costal cartilage in total auricle reconstruction,so as to provide reference for the improvement of related surgical techniques.Methods:The clinical data of patients diagnosed with unilateral microtia syndrome who underwent onestage surgery for auricular reconstruction with NAGATA method admitted to the Department of Plastic Surgery of Henan Provincial People’s Hospital from June 2016 to June 2021 were collected.They were divided into the traditional group(data before December 2018)and the modified group(data after December 2018)according to whether the modified costal cartilage harvesting technique was used or not.In the modified group,a combination of small incisions without cutting off muscle tissue and intercostal nerve block was performed with special surgical instrument assisted replanting of costal cartilage fragments.Patients with complete clinical data and postoperative follow-up time of more than 6 months were selected and included in the two groups for study.50 patients who met the criteria were included in the traditional group(There were 11 females and 39 males,ranging from 6 to 27 years old,with an average age of 11.48± 5.88 years old),and 54 patients who met the criteria were included in the modified group(There were 10 females and 44 males,ranging in age from 6 to 27 years,with an average age of 10.8±4.01years).The postoperative recovery of thoracic symmetry of patients in the modified group,the recovery of chest donor site of patients in the two groups and the occurrence of common complications in the donor site and perioperative indicators were compared,mainly including:(1).The long-term postoperative thoracic symmetry recovery of some patients in the improved group: thoracic CT scan and costal cartilage three-dimensional reconstruction to observe the recovery of thoracic support structure in the donor site,costal cartilage donor side and non-surgical side of the same plane thoracic anterior and posterior diameter measurement,analysis of the degree of thoracic collapse deformity in the modified group;(2).long-term recovery of chest donor site shape and appearance: scar length,scar score,incidence of different degrees of thoracic deformity and patient satisfaction;(3).Incidence of common donor site complications(pneumothorax,subcutaneous hematoma,infection);(4).perioperative indicators: intraoperative blood loss,operation time,postoperative 1 day chest donor site pain score.Results:1.Thoracic CT scan and three-dimensional reconstruction of costal cartilage showed that most of the thoracic support structures in the chest donor site in the modified group had better recovery.Comparison of the measured values of the anterior and posterior diameters of the thorax on the same plane of the surgical side and the non-surgical side of the costal cartilage donor site in 34 patients in the improved group:Comparison of the anterior and posterior thoracic diameters of the operated side of the 6th costal cartilage plane(17.92 ± 1.88)cm and the non-operated side(18.08 ± 1.94)cm,and there was no significant difference(P>0.05);Comparison of the anterior and posterior thoracic diameters of the operated side of the7 th costal cartilage plane(17.59±2.0)cm and the non-operated side(17.91±2.0)cm,and there was no significant difference(P>0.05);The sum of the measured anteroposterior diameters of the thorax in the 6th and 7th costal cartilage planes of the operated side(35.51±3.86)cm was compared with that of the nonoperated side(35.99±3.99)cm,and there was no significant difference(P>0.05).2.Long-term recovery of shape and appearance of chest donor site: the scar length of the modified group was(2.89±0.5)cm,which was significantly shorter than that of the traditional group(8.04±1.76)cm,and the difference had statistical significance(P<0.01);Comparison of Vancouver Scar Scale scores between the two groups,and the difference had statistical significance(P<0.01);the incidence of thoracic deformity in the modified group of 54 patients: basically normal in 44 cases(81.5%),mild deformity in 9 cases(16.7%),and severe deformity in 1 case(1.85%).The incidence of thoracic deformity in 50 patients in the traditional group was basically normal in 11 patients(22%),mild deformity in 30patients(60%),and severe deformity in 9 patients(18%),Incidence of thoracic deformity(mild+severe)in the modified group(18.55%)was significantly lower than the incidence of thoracic deformity(mild+severe)in the conventional group(78%),and the difference was statistically significant(P<0.01);the patient satisfaction in the modified group(88.9%)was significantly higher than that in the traditional group(36%),and the difference was statistically significant(P<0.01).3.Incidence rate of common complications in chest donor site(pneumothorax,subcutaneous hematoma,infection): incidence rate of common complications in improved group(5.6%)and traditional group(10%),and there was no significant difference(P>0.05).4.Perioperative indicators: the intraoperative blood loss of(12.69±3.46)ml in the modified group was significantly less than that of(18.20±4.14)ml in the traditional group,and the difference had statistical significance(P<0.01);The operation time of the improved group was(233.07 ± 21.85)min,compared with(231.26 ± 23.28)min of the traditional group,and there was no significant difference(P>0.05);the daily visual analogue scale of donor site pain within one week after operation in the modified group was lower than that in the control group,the difference had statistical significance(P<0.01).Conclusions:For the patients with total auricle reconstruction,the incidence of thoracic collapse deformity was effectively reduced by the comprehensive improvement technique.Scar smallness is beneficial to improve patient satisfaction.Although the small incision design increased the difficulty of surgical field exposure and operation,the costal cartilage resection could be successfully completed through the improvement of surgical instruments and operation techniques,and the overall time of total auricle reconstruction and the incidence of common complications in the chest donor site did not increase significantly.Blunt muscle tissue separation also significantly reduced intraoperative bleeding and alleviated postoperative pain.The comprehensive improvement technique has significant advantages in alleviating complications of the donor site of the chest.This study provides a reference for the improvement of the surgical technique of total auricle reconstruction and other procedures requiring the removal and transplantation of costal cartilage.