Objective:To compare the physical properties of three-dimensional porous scaffolds with varying concentrations of acellular cartilage matrix (ACM), and to identify an optimal plan for the constructing tissue-engineered cartilage.Methods:(1) The cartilage particles were obtained by sampling, freezing, and crushing bovine knee cartilage. (2) ACM from was extracted from bovine articular cartilage through trypsin digestion, nuclease digestion, washing, and purification of cartilage particles. (3) Three-dimensional porous scaffolds were constructed using different concentrations of ACM: group A (100%), group B (60%), and group C (30%). (4) The scaffolds underwent gross observation, histological evaluation, DNA quantification, microstructural analysis, and measurement of physical properties.Results:Histological analysis revealed no discernible cell morphology or residual cell fragments in the ACM scaffolds across all groups. Hematoxylin and eosin (HE) staining, along with Sirius red staining, indicating the presence of collagen, suggesting retention to a certain extent. DNA quantification demonstrated a residual DNA concentration of (1.103 ± 0.174) ng/mg, confirming that the scaffolds were completely acellular. Scanning electron microscopy showed that the pore diameter of scaffolds in groups A, B, and C significantly decreased with the increase of ACM concentration, with no significant differences among the groups. Physical parameters indicated that scaffold density, yield strength, and Young’s modulus in groups A, B, and C were positively correlated with ACM concentration, while water absorption and porosity were negatively correlated. The pore diameters of scaffolds in all three groups ranged between 100 and 200 μm, with porosity exceeding 80%. Additionally, the water absorption and expansion rates were all above 450%, meeting the requirements for tissue engineering scaffolds. The Young’s modulus for scaffolds in group A and group B was (4.440±0.340) MPa and (0.963±0.320) MPa, respectively, which approached the mechanical properties of normal human articular cartilage.Conclusion:The three-dimensional porous scaffolds constructed with ACM at 100% and 60% concentrations demonstrate high water absorption and expansion rate, porosity, pore diameter, and mechanical properties comparable to those of normal cartilage tissue, making them suitable alternatives for tissue-engineered cartilage construction.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:To compare the physical properties of three-dimensional porous scaffolds with varying concentrations of acellular cartilage matrix (ACM), and to identify an optimal plan for the constructing tissue-engineered cartilage.Methods:(1) The cartilage particles were obtained by sampling, freezing, and crushing bovine knee cartilage. (2) ACM from was extracted from bovine articular cartilage through trypsin digestion, nuclease digestion, washing, and purification of cartilage particles. (3) Three-dimensional porous scaffolds were constructed using different concentrations of ACM: group A (100%), group B (60%), and group C (30%). (4) The scaffolds underwent gross observation, histological evaluation, DNA quantification, microstructural analysis, and measurement of physical properties.Results:Histological analysis revealed no discernible cell morphology or residual cell fragments in the ACM scaffolds across all groups. Hematoxylin and eosin (HE) staining, along with Sirius red staining, indicating the presence of collagen, suggesting retention to a certain extent. DNA quantification demonstrated a residual DNA concentration of (1.103 ± 0.174) ng/mg, confirming that the scaffolds were completely acellular. Scanning electron microscopy showed that the pore diameter of scaffolds in groups A, B, and C significantly decreased with the increase of ACM concentration, with no significant differences among the groups. Physical parameters indicated that scaffold density, yield strength, and Young’s modulus in groups A, B, and C were positively correlated with ACM concentration, while water absorption and porosity were negatively correlated. The pore diameters of scaffolds in all three groups ranged between 100 and 200 μm, with porosity exceeding 80%. Additionally, the water absorption and expansion rates were all above 450%, meeting the requirements for tissue engineering scaffolds. The Young’s modulus for scaffolds in group A and group B was (4.440±0.340) MPa and (0.963±0.320) MPa, respectively, which approached the mechanical properties of normal human articular cartilage.Conclusion:The three-dimensional porous scaffolds constructed with ACM at 100% and 60% concentrations demonstrate high water absorption and expansion rate, porosity, pore diameter, and mechanical properties comparable to those of normal cartilage tissue, making them suitable alternatives for tissue-engineered cartilage construction.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:To construct a virtual-real interactive system HE-01 for the treatment of microtia based on HoloLens and verify the feasibility of applying HE-01 in ear reconstruction.Methods:Six volunteers (3 males and 3 females, average age: 20.5 years old) and six patients with microtia(3 males and 3 females, average age: 7.6 years old) were recruited from Plastic Surgery Hospital of Chinese Academy of Medical Sciences from August to September 2021. The Mimics Research 21.0 software and 3-matic research software were used to construct a virtual three-dimensional auricle model. Based on HoloLens and occlusal splint navigation marker device, the virtual-real interactive system HE-01 for the treatment of microtia was constructed. The registration accuracy, tracking delay and display effect of different colors (red, green, blue and skin color) of HE-01 were evaluated through repeated experiments of volunteers. The operation process was defined through repeated experiments of patients and the feasibility of applying HE-01 in auricular reconstruction was verified.Results:HE-01 was built successfully and the operation flow was clear. The experiment of six volunteers (12 ears) showed a high registration accuracy (average error rate 2.3%-2.4%, less than 2.7% of the bilateral auricle size difference of normal people), low tracking delay (six volunteers were all less than 0.1 s), and best green and red display effect of virtual auricle guide under different angles (-60°, -30°, 0°, 30°, 60°). Experiments of patients with microtia showed that HE-01 could be applied to auricular reconstruction, and there were no obvious complications in wearing the navigation marker device, which had repeatability and stability.Conclusion:This study has completed the conceptual design of augmented-reality assisted auricular reconstruction based on navigation device, CT data and HoloLens. HE-01 has good registration accuracy, tracking speed and display effect, laying a good foundation for further software development and clinical transformation.

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.

The nomenclature of congenital auricular malformations is complex and confusing, which brings great inconvenience to clinical work and scientific research. This study comprehensively summarized and sorted out the existing Chinese and English names of congenital auricular malformations, providing reference basis for the scientific classification and clinical treatment of congenital auricular malformations. Sixty-seven papers on the topic of congenital auricle malformations were collected from databases such as CNKI, Wanfang Database, VIP Database, PubMed, Web of Science, and ScienceDirect by using the PRISMA method. The two core issues of morphological and anatomical naming and classification of congenital auricle malformations were sorted and summarized based on these articles. In this study, the existing Chinese and English names of congenital auricular malformations were summarized, and a preliminary classification was made at the morphological and anatomical levels, and the embryological origin of the external auricle and its substructures was elaborated. Based on the result of this study, a comprehensive analysis can be conducted on the malformations of the ear structures and their embryological origins in order to explore the etiology of congenital ear malformations. It is expected that scientific and standardized naming and classification method can be developed, and reasonable and effective standardized treatment can be formulated for congenital auricular malformations based on this study.

Objective:To explore the clinical effect of non-expansion whole framework ear reconstruction for microtia (referred to as the NEWF ear reconstruction).Methods:The clinical data of congenital microtia patients underwent NEWF ear reconstruction at Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. This advanced method used a tissue non-expansion approach, employing a double flap consisting of preauricular skin flap and fascia flaps, to fabricate and elevate the ear framework in the first stage concurrently. In the subsequent stage, residual ear tissues were utilized to reconstruct key elements such as the tragus, crus of the helix, cavum concha, and so on. At 6 months follow-up, the effectiveness of the reconstructed ear was assessed based on its aesthetic outcomes and complications. Aesthetic outcomes evaluation included 4 items: skin color (front of ear, back of ear and skin graft area were evaluated respectively), appearance of reconstructed ear substructure, scar of incision and hair condition. The individual score was 0-2 points, total scores from 0 to 10, with scores of 9-10 signifying excellent, 6-8 good, 3-5 moderate, and 0-2 poor. The data were analyzed by descriptive statistics.Results:Ear reconstruction was performed on 49 unilateral microtia cases, aged 6-33 years, including 37 males and 12 females, 34 right ears and 15 left ears. According to the Nagata classification: 30 cases were lobule-type, 5 cases were conchal-type, and 14 cases were small conchal-type. The follow-up period averaged 10.63 months, ranging from 6 to 13 months. One patient experienced exposure of the framework 1 month after the first stage surgery, then recovered well after surgery. The skin color of the front side of the reconstructed ear was close to normal, the substructure was clear, the skin graft area behind the ear recovered well, and the reconstructed ear was basically symmetrical with the healthy side. 9 cases (18.4%) had scar hyperplasia in the mastoid area behind the ear. 9 cases (18.4%) had hair growth on the front of the reconstructed ears. Aesthetic outcomes showed that excellent in 8 cases (16.3%), good in 36 cases (73.5%), moderate in 4 cases (8.2%), poor in 1 case (2.0%).Conclusion:The NEWF ear reconstruction enhances the stability of the ear framework, reduces the overall duration of treatment, making it a viable option for ear reconstruction for microtia.

Objective:To construct a virtual-real interactive system HE-01 for the treatment of microtia based on HoloLens and verify the feasibility of applying HE-01 in ear reconstruction.Methods:Six volunteers (3 males and 3 females, average age: 20.5 years old) and six patients with microtia(3 males and 3 females, average age: 7.6 years old) were recruited from Plastic Surgery Hospital of Chinese Academy of Medical Sciences from August to September 2021. The Mimics Research 21.0 software and 3-matic research software were used to construct a virtual three-dimensional auricle model. Based on HoloLens and occlusal splint navigation marker device, the virtual-real interactive system HE-01 for the treatment of microtia was constructed. The registration accuracy, tracking delay and display effect of different colors (red, green, blue and skin color) of HE-01 were evaluated through repeated experiments of volunteers. The operation process was defined through repeated experiments of patients and the feasibility of applying HE-01 in auricular reconstruction was verified.Results:HE-01 was built successfully and the operation flow was clear. The experiment of six volunteers (12 ears) showed a high registration accuracy (average error rate 2.3%-2.4%, less than 2.7% of the bilateral auricle size difference of normal people), low tracking delay (six volunteers were all less than 0.1 s), and best green and red display effect of virtual auricle guide under different angles (-60°, -30°, 0°, 30°, 60°). Experiments of patients with microtia showed that HE-01 could be applied to auricular reconstruction, and there were no obvious complications in wearing the navigation marker device, which had repeatability and stability.Conclusion:This study has completed the conceptual design of augmented-reality assisted auricular reconstruction based on navigation device, CT data and HoloLens. HE-01 has good registration accuracy, tracking speed and display effect, laying a good foundation for further software development and clinical transformation.

Objective:To analyze the characteristics of postoperative thoracic deformation in patients who underwent multi-rib autologous rib cartilage transplantation auricle reconstruction based on 3dMD imaging system.Methods:A retrospective study was conducted using 3dMD data of the thorax from patients who underwent auricle reconstruction surgery using multiple autologous costal cartilages at the First Department of Ear Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from July to September 2019. The normal-side chest wall image was superimposed on the rib-harvested side chest wall for automatic registration and alignment, with distance numerical data presented in a Cartesian heat map through color mapping technology. By observing the areas where the rib-harvested side thorax had obvious deformation, the distance difference of the concave and convex peaks on the sagittal diameter was measured to judge the degree of thoracic deformation in children (≤10 mm as none; >10-20 mm as mild; >20-30 mm as moderate; >30 mm as severe).Results:A total of 42 children were included, with 27 males and 15 females, aged from 7 to 12 years old. The Cartesian heat map of thoracic deformation showed that the obvious concave area of the chest wall was located at the junction of the middle and inner one-third of the clavicle and the 7th rib, and the obvious convex area was located in the area from the nipple to the 5th rib. The measurement range of the protrusion peak in the upper chest nipple area was from -7.638 9 to -14.288 4 mm; the measurement range of the depression peak in the rib arch area was from 7.238 7 to 14.653 2 mm. The range of the distance difference between the concave and convex peaks was from 14.877 6 to 28.941 6 mm.The degree and incidence of thoracic deformation in children: mild in 5 cases; moderate in 37 cases.Conclusion:Based on the analysis with 3dMD photogrammetry, the overall characteristics of chest wall deformation in patients who underwent ear reconstruction with autologous rib cartilage grafts were the coexistence of protrusion in the upper chest nipple area and depression in the area where the rib cartilage was harvested, with changes occurring on the sagittal diameter.