Chicago, Ill. From Children's Memorial Hospital.
Plast Reconstr Surg. 2009 Jul;124(1 Suppl):14e-26e. doi: 10.1097/PRS.0b013e3181aa0e79.
The reconstruction of microtia continues to represent one of the more challenging plastic surgery procedures. The limitations of the reconstruction are partly inherent in the soft-tissue deficiencies present in increasing degrees from large conchal remnant microtia, to lobular microtia, to the displaced remnant in auricular dystopia, and partly because of the high level of technical expertise required. After a brief review of the history of ear reconstruction in general and microtia specifically, issues related to the transition in the popularity from techniques involving three or more stages (Tanzer and Brent) to the current popularity of two-stage procedures (Nagata, Firmin, and Park) are discussed in detail. Each of the popular procedures is viewed in relation to timing of the reconstruction, procedure planning, and how both the soft tissues and framework construction are handled, in each of the stages. The most significant differences include whether the autogenous cartilage framework is constructed with or without the tragal construct (for the lobular-type microtia), whether or not the lobule is rotated in the first-stage reconstruction, whether an additional cartilage block is placed behind the framework for added ear projection, and how that added block is covered (choice of fascia flap and skin graft). Each of the techniques has to be varied in reconstruction of auricular dystopia in light of the associated skeletal and soft-tissue hypoplasia. In this article, the author demonstrates that although there may be significant advantages to the two-stage reconstructions of Nagata and Firmin, some may feel that the larger amount of cartilage harvested, the later optimal age for beginning the reconstruction, the additional scalp scars engendered by using the temporoparietal fascia flap in the second-stage elevation of the framework, and even the exchange of lobule tissue (and ability to later pierce ears) to obtain better coverage of the concha and tragus are unacceptable. Having gained experience with each of the varied approaches and having modified them when unusual variations in deformities have required it, the author discusses his current preferences. Clearly, this author feels that there may be significant advantages to delaying the reconstruction to age 10 years or older, yet experience gained over the past 25 years would seem to indicate that as in all other aspects of plastic and reconstructive surgery one must never be wed to a single approach, and experience and flexibility are essential in obtaining the optimal outcome in all variations of the deformity.
小耳畸形的重建仍然是整形外科中具有挑战性的手术之一。重建的局限性部分是由于软组织结构的固有缺陷，从大耳畸形的残余耳甲腔、小耳畸形到耳畸形的残余耳，这种缺陷程度逐渐增加，部分原因是重建所需的技术水平较高。在简要回顾了一般耳部重建和小耳畸形重建的历史之后，详细讨论了从涉及三个或更多阶段的技术（Tanzer 和 Brent）到目前两阶段手术（Nagata、Firmin 和 Park）的受欢迎程度的转变。每种流行的手术都与重建的时间安排、手术规划以及在每个阶段如何处理软组织和框架结构有关。最显著的差异包括自体软骨框架是带有还是不带有耳屏结构构建（对于小耳畸形）、在第一阶段重建中是否旋转耳轮、是否在框架后面放置额外的软骨块以增加耳朵的突出度，以及如何覆盖增加的软骨块（筋膜瓣和皮片的选择）。在重建耳畸形时，每种技术都需要根据相关的骨骼和软组织发育不良进行调整。在本文中，作者表明，尽管 Nagata 和 Firmin 的两阶段重建可能具有显著优势，但有些人可能认为，采集的软骨量更大、开始重建的最佳年龄更晚、使用颞顶筋膜瓣在第二阶段升高框架时产生的额外头皮疤痕，甚至是耳轮组织的交换（以及获得更好的耳甲腔和耳屏覆盖的能力），都是不可接受的。作者在获得各种方法的经验后，根据畸形的不同情况对方法进行了修改，并讨论了自己的偏好。显然，作者认为将重建推迟到 10 岁或更大年龄可能具有显著优势，但过去 25 年的经验表明，就像在整形和重建外科的所有其他方面一样，人们决不能只坚持一种方法，经验和灵活性对于获得所有畸形类型的最佳结果至关重要。
