Efficacy of personalized expander placement in single expanded flap ear reconstruction surgery
10.3760/cma.j.cn114453-20241019-00267
- VernacularTitle:个性化埋置扩张器在全扩张皮瓣法耳廓再造术中的应用效果
- Author:
Chenglong WANG
1
;
Li GUO
1
;
Tiantian YIN
1
;
Dejin GAO
1
;
Rui GUO
1
;
Jiaxin LIANG
1
;
Qingguo ZHANG
1
Author Information
1. 中国医学科学院北京协和医学院整形外科医院综合整形科，北京 100144
- Publication Type:Journal Article
- Keywords:
Congenital microtia;
Soft tissue expander;
Reconstruction of auricle;
Flap
- From:
Chinese Journal of Plastic Surgery
2025;41(3):270-276
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application and efficacy of personalized expander placement in the single expanded flap auricular reconstruction for microtia.Methods:This study was a prospective cohort study that included patients with microtia who underwent single expanded flap auricular reconstruction in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences between February 2023 and March 2024, according to specific inclusion and exclusion criteria. During the first-stage surgery, the tension and thickness of the skin in the postauricular area were evaluated using a pinch test. The anatomical layer of the expander placement was personalized as follows: (1) for thicker skin, the expander was placed in the subcutaneous layer; (2) for thinner skin, the expander was placed in the subcutaneous layer in the scalp region and in the subfascial layer in the hairless region behind the ear; (3) for areas of thin skin behind the residual ear, the expander was placed in the subfascial layer, with the remainder in the subcutaneous layer. In the second-stage surgery, autologous costal cartilage scaffolds were implanted for ear reconstruction, followed by a third-stage revision surgery. Postoperative follow-up was conducted to record complications. Before the third-stage surgery, two plastic surgeons, who did not participate in the operations, evaluated the aesthetic outcomes of the reconstructed ear using the Likert 4-point scale (1-4 points, with higher scores indicating better aesthetic outcomes).Results:A total of 152 children were included, with 97 males and 55 females; ages ranged from 5 to 13 years old, with a mean age of 6.8 years old. Of these, 89 cases were right-sided microtia, 53 left-sided microtia, and 10 bilateral microtia. In terms of skin characteristics, 35 cases had thick skin, 69 thin skin, and 48 thin skin behind the residual ear. During the first-stage surgery, complications included 15 cases of expander hematoma and 3 cases of expander infection. Both were controlled with symptomatic treatment. No cases of expander exposure occurred. The second-stage follow-up ranged from 6 to 12 months, with a mean of 7.9 months. The thickness of the reconstructed ear skin was appropriate, with well-defined subunits and no exposure of the cartilage scaffold. The aesthetic score for the reconstructed ear was (3.3 ± 0.5) points.Conclusion:The personalized placement of expanders effectively ensured appropriate thickness of the expanded flap in single expanded flap auricular reconstruction, providing good coverage for the rib cartilage framework and significantly enhancing the aesthetic outcomes of the reconstructed ears.
