Kim Young Soo
Bona Microtia and Aesthetic Ear Surgery Clinic, Seoul, Korea.
Arch Plast Surg. 2013 May;40(3):192-7. doi: 10.5999/aps.2013.40.3.192. Epub 2013 May 16.
To construct a sophisticated three-dimensional framework, numerous modifications have been reported in the literature. However, most surgeons have paid little attention to the anatomical configuration of the concha and more to its deepness and hollowness, leading to unsatisfactory outcomes.
For a configuration of the concha that is definitely anatomical, the author further developed and employed the conchal bowl element, which has been used by several surgeons although the results have not been published elsewhere. The author constructed the conchal bowl element in one of three patterns according to the amount of available cartilages: one block, two-pieces, or a cymba bowl element only. A total of 20 patients underwent auricular reconstruction using a costal cartilage framework between 2009 and 2012. The 8 earliest reconstructions were performed without a conchal bowl element and the latter 12 with a conchal bowl element. The patients were followed up for more than 1 year. The aesthetic results were scored by evaluating characteristics involving the stability of the crus helicis, the conchal definition, and the smoothness of the helical curve.
The ears reconstructed early without a conchal bowl element showed a shallow and one or two incompletely separated concha with an obliterated cymba conchal space. They also did not have a realistic or smooth curve of the helix because of an unstable crus helicis. However, ears reconstructed later with the concha bowl element showed a definite crus helicis, deep cymba conchal space, and smooth helical curve.
The construction of the conchal bowl element is simple, not time-consuming procedure. It is suggested that the conchal bowl element must be constructed and attached to the main framework for natural configuration of the reconstructed ear.
为构建一个精致的三维框架，文献中已报道了众多改良方法。然而，大多数外科医生较少关注耳甲的解剖结构，而更多关注其深度和凹陷程度，导致效果不尽人意。
为实现绝对符合解剖结构的耳甲形态，作者进一步研发并应用了耳甲碗状结构单元，尽管其结果尚未在其他地方发表，但已有几位外科医生使用过。作者根据可用软骨的数量，以三种模式之一构建耳甲碗状结构单元：一块、两块或仅一个耳甲艇碗状结构单元。2009年至2012年间，共有20例患者使用肋软骨框架进行了耳廓再造。最早的8例再造手术未使用耳甲碗状结构单元，后12例使用了耳甲碗状结构单元。对患者进行了超过1年的随访。通过评估包括耳轮脚稳定性、耳甲清晰度和耳轮曲线平滑度等特征对美学效果进行评分。
早期未使用耳甲碗状结构单元进行再造的耳朵显示耳甲浅，有一或两个未完全分开的耳甲，耳甲艇间隙消失。由于耳轮脚不稳定，它们也没有逼真或平滑的耳轮曲线。然而，后期使用耳甲碗状结构单元再造的耳朵显示有明确的耳轮脚、深的耳甲艇间隙和平滑的耳轮曲线。
耳甲碗状结构单元的构建是一个简单、不耗时的过程。建议必须构建耳甲碗状结构单元并将其附着于主框架上，以实现再造耳的自然形态。
