Today, I will summarize the advantages and disadvantages of various methods of ear reconstruction surgery.
There are many kinds of operations for microtia, which are divided into one-time plastic surgery and staged plastic surgery. From the material point of view, it can be divided into self-material method and biological material method; From the operation process, it can be divided into all-inclusive method and half-inclusive method; From the perspective of surgical methods, it can be divided into expansion method and non-expansion method; From the part of ear reconstruction, it can be divided into total ear reconstruction and partial ear reconstruction.
These methods are not only used in actual clinical treatment, but also used in many ways. For example, some of my patients chose the all-inclusive method of expanding their own materials by water injection and had a third-stage operation.
Several common surgical methods of ear reconstruction
Ear reconstruction operation
One-off ear reconstruction refers to ear reconstruction that can make the external ear contour good and only stand up once. One plastic surgery can choose autologous materials or biomaterials, and skin grafting is needed. Skin grafts can be taken from scalp, stomach and chest.
The operation time is about 4 hours, and an experienced doctor needs about 3 and a half hours. When the stitches were removed on 10 day after operation, the color and shape of the newly removed ear were quite different from those of the normal ear. Generally, it takes half a year to one year to gradually restore the color and shape of the normal ear.
The advantages are short time and one-step molding; The cost is lower than that of the phased method. Disadvantages are more bleeding during operation and slow recovery after operation. The skin after skin grafting has color difference with the normal skin in other parts of the ear. The whiter the skin, the less obvious the color difference.
Staged ear reconstruction
Phased ear reconstruction is a surgical method, which requires two or three operations to create a perfect ear. Autologous materials and biomaterials can be divided into stages. The operation I often do is skin expansion and total ear reconstruction. The operation is divided into three stages.
One-stage operation: the dilator was implanted with water, and 100ml water bag (skin and soft tissue dilator) was implanted in the mastoid region behind the ear, and the hospitalization time was about 7 days; Normal saline was injected one week after implantation, and water injection was completed in about 1 ~ 2 months.
The second operation: take out the dilator, cut the costal cartilage and carve the ear bracket, and then use the expanded skin as the auricle skin to complete the auricle reconstruction.
The third stage operation: About 6 months after the second stage operation, the earlobe transposition, concha cavity and tragus reconstruction were carried out on the basis of auricle reconstruction, and the exquisite ears were more realistic.
The advantage of this kind of operation is that the ears are very realistic and can almost be confused with reality; The disadvantage is that the operation period is long and the cost is more than one-time molding.
The difference between full inclusion method and semi-inclusion method
All-inclusive method means that the skin needed for ear stent implantation is left at one time during the first-stage operation, and skin grafting is not needed; The expansion time of water injection by semi-wrapping method is short, only the skin in front of the ear is expanded, and the skin behind the ear needs skin grafting.
The difference between autologous materials and biomaterials
Autologous material refers to the ear bracket carved with the soft rib of the font; Biomaterials are high-tech new materials, not materials from organisms. Ear hooks are ready-made and do not need to be carved.
Difference between expansion method and non-expansion method
Expansion requires implanting a dilator into the skin of the ear to inject water.
Non-expansion method means that the ear skin is not expanded. In the first stage, the ear bracket is placed under the ear skin, and in the second stage, it will be rebuilt and erected. The reconstructed ear needs to be covered with skin graft, commonly known as "direct burial". Because the residual ear can be finely trimmed in the first stage of ear reconstruction, the "direct burial method" can obtain satisfactory reconstructed ear after two operations.
Difference between total ear reconstruction and partial ear reconstruction
Total ear reconstruction is mainly suitable for edentulous, sausage-like microtia and microtia with only one concha cavity. In this case, it is necessary to reconstruct the whole ear or all structures except the earlobe, which is usually called total ear reconstruction.
But there are also some patients whose ears are not completely missing, and there is a small concha cavity. If the size of the remaining part is more than half of the contralateral good ear, I will adopt the method of partial ear reconstruction, that is, keep most of the remaining ear and supplement the insufficient part. In this case, fascia flap and skin graft can be used for one-step molding technology, or all-inclusive method can be used, which is superior to one-step molding technology in color and texture.