Constantine Kristin K, Gilmore Jim, Lee Kenneth, Leach Joseph
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas.
JAMA Facial Plast Surg. 2014 Jul-Aug;16(4):240-4. doi: 10.1001/jamafacial.2014.30.
Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia.
To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review from January 1, 2001, through December 31, 2012, at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis.
Reconstructive surgery for microtia.
We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match.
The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant.
Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.
耳廓再造是美容与功能的独特融合。对于小耳畸形患者而言，选择最佳的支架材料是一项重要决策。
评估并比较使用多孔聚乙烯植入物和肋软骨移植进行小耳畸形再造的效果。
设计、地点和参与者：对一所三级学术机构2001年1月1日至2012年12月31日期间的病历进行回顾性研究。35例（36耳）接受小耳畸形修复的患者被分为使用高密度多孔聚乙烯组（17耳）、肋软骨组（17耳）和两种材料联合使用组（2耳）。仅纳入修复完成的患者进行分析。
小耳畸形的重建手术。
我们比较了各组的平均手术次数、开始治疗时的年龄以及并发症（感染、排斥、软骨外露和气胸）情况。由不知情的观察者对照片进行评分，以给每位患者的耳廓突出度、清晰度、形状、大小、位置和颜色匹配度打分。
软骨组患者的年龄大于聚乙烯组（平均年龄分别为8.0岁和6.9岁；P = 0.23）。软骨组的平均手术次数为4.88次，而聚乙烯组为3.35次（P = 0.004）。聚乙烯组有2例患者术后发生感染和植入物排斥，随后接受了肋软骨移植重建。软骨组患者无感染或排斥发生；1例有轻微软骨外露。无患者发生气胸。聚乙烯组患者的耳廓清晰度和大小匹配度评分明显更高，而软骨组患者的颜色匹配度明显更好。软骨组患者的耳廓突出度和位置效果更好，尽管差异不显著。
多孔聚乙烯植入物和肋软骨移植重建的比较表明，两种材料均无明显优势。聚乙烯植入物在耳廓清晰度、形状和大小方面可能获得更好的美容效果，但感染和排斥风险更高。软骨组患者年龄较大，手术次数明显更多，这在选择技术时应作为考虑因素。
3级。
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