Implant double tissue expanders superposingly in mastoid region for total ear reconstruction without skin grafts.

To present our clinical experience in using two skin soft-tissue expanders implanted superposingly in the mastoid region and Medpor ear framework for congenital microtia reconstruction. The process of our technique is divided into three stages. In the first surgical stage, a 50 cm(3) and 80 cm(3) kidney-shaped expander is implanted under the fatty layer in mastoid region. Overlay the big expander on the small one. After the first surgery stage they are inflated alternately. In the second surgical stage, we remove two skin soft-tissue expanders and fix the Medpor ear framework to the fascial tissue which is covered by the expanded skin flap wholly without application of fascial flap. In the third stage, we perform the transposition of the auricular lobule to the designated position, construction of the tragus and refinement the new reconstructed ear. From January 2009 to December 2010, 27 patients were treated by this method of total ear reconstruction. 27 patients acquired symmetrical, subtle contour, prominent reconstructed auricles. The new reconstructed ear had a good contour and its skin color and texture were nearly the same as the normal surrounding skin. The postauricular sulcus was stable and satisfactory. The postoperative follow-up time ranged from 1 to 3 years. The expanded skin flap took well without necrosis. Exposure of the skin expander occurred in 2 patients (7.4%). The Medpor ear framework was extrused in one patient (3.7%). In addition, the hematoma was observed in 3 patients (11.1%). No other severe complications happened. Overlying implantation of two skin-soft skin expanders solves the problem of insufficient amount of the skin flap, avoids postauricular skin grafting, simplifies the surgical procedure and shortens the operation time significantly.

Zhang GL ，Zhang JM ，Liang WQ ，Chen YH ，Ji CY ... -  《-》

Microtia reconstruction using tissue expanders without skin grafts from groin region.

Microtia reconstruction is a multistage procedure for which a variety of surgical strategies have been devised. Most surgeons continue to employ the long-established two-stage procedures described by Nagata and Firmin, which use autogenous rib cartilage for auricular reconstruction. The groin area is the most common donor site for full-thickness skin grafts in auricular elevation, the second stage. In this article, we present a new method that uses tissue expanders before auricular elevation, which provides the necessary skin and creates satisfactory results without groin scarring. The surgical procedure is composed of three stages. In the first stage, we performed the rib-cartilage graft as previously described. In the second stage, a 45-ml rectangular tissue expander was inserted subcutaneously at the postauricular mastoid region. The skin flap was expanded for 3-4 months before auricular elevation. In the next stage, the expanded postauricular skin flap was advanced to the mastoid area and set into the auriculocephalic sulcus after removing of the tissue expander. The estimated remnant skin flap and dog-ears were marked and then excised. After a defatting procedure, the harvested skin was reused for the elevation procedure, obviating the need for full-thickness skin from the groin. Between January 2011 and January 2014, 62 cases of microtia were treated with our method. The final results showed no major complications and satisfactory aesthetics, with fine structure, symmetry, maintenance of the auriculocephalic angle, and erect stability of the cartilage framework. Various procedures using tissue expanders have been introduced in microtia reconstruction. However, they utilized complicated strategies for tissue expanders or obtained suboptimal aesthetic results. With our simple and reproducible methods, we can obtain satisfactory aesthetic results using expanded skin without the additional morbidity of a donor site. Despite the addition of an operation procedure, patient satisfaction with regard to the lack of groin scarring was much higher than expected.

Park BY ，Im JT ，Lim SY ，Pyon JK ，Bang SI ，Mun GH ，Oh KS ... -  《-》

Combined fascial flap and expanded skin flap for enveloping Medpor framework in microtia reconstruction.

Yang SL ，Zheng JH ，Ding Z ，Liu QY ，Mao GY ，Jin YP ... -  《-》

Reconstruction of Microtia Using a Single Expanded Postauricular Flap without Skin Grafting: Experience of 683 Cases.

Xing W ，Kang C ，Wang Y ，Zhang Q ... -  《-》

Total auricular reconstruction without skin grafting.

Successful ear reconstruction depends on two factors: an ear framework and the skin covering the framework. However, the relative deficiency of skin for coverage of the cartilage framework remains an issue. This new method for total auricular reconstruction is a three-stage operation and involves the use of two tissue expanders. First, two skin expanders are implanted, one underneath the scalp and the other sited behind the microtic ear. At the second stage, after lobule transposition, the two expanded skin flaps (upper and lower) and mastoid fascial flap are raised. At the same time, the autogenous rib cartilage is harvested and the framework constructed. The cartilage framework is then anchored between the upper expanded skin flap and the fascial flap with its inferior pole inserted into the rotated earlobe. The upper expanded skin flap covers the whole anterior surface of the framework and drapes over the margins of the fascial flap, which wrap the framework from beneath. The raw surface of fascial flap is covered with the lower expanded skin flap. The formation of a pseudomeatus and tragus is performed at the third stage. Deficiency of skin is the major problem encountered with the other conventional methods. Our innovations using two tissue expanders in combination with an autogenous rib cartilage framework eliminate this problem completely.

Liu J ，Sun J ，Li X 《-》