Sharma Mohit, Dudipala Raghuveer Reddy, Mathew Jimmy, Wakure Abhijeet, Thankappan Krishnakumar, Balasubramaniam Deepak, Iyer Subramania
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Plast Surg. 2015 May-Aug;48(2):144-52. doi: 10.4103/0970-0358.163050.
An ideal ear, with representation of all anatomic landmarks, is the aim of any reconstructive surgeon embarking on reconstructing the ear in a microtia patient. The literature is abundant with the description of techniques, but these have been reported mainly in Caucasian and Oriental population. There have been very few publications on results in the population belonging to the Indian subcontinent. In spite of strictly adhering to the recommended techniques of reconstruction, the results obtained in these patients have often been marred by problems that are not reported with the Oriental or Caucasian populations. This may necessitate a relook into the management strategy of these cases. Hindering the assessment of the results, their reporting and auditing the improvement obtained by such change in the management strategy, is the lack of a standardized method for assessment of the outcome. Hence, an attempt was made in a series of patients who underwent microtia reconstruction to assess the outcome using a new tool based on the attained definition of anatomical components of the reconstructed pinna. Further effort was made to document the modifications in the technical execution of the reconstruction during the period of the study.
A retrospective review of 44 patients and a prospective analysis of 11 patients, who underwent ear reconstruction for microtia from December 2003 to September 2014 at a tertiary care teaching hospital, was undertaken. Taking a cue from Nagata's description of an 'ideal reconstructed ear' which should show all the anatomical components, we developed an objective grading system to assess our results. The technique had undergone several changes during these years combining the principles of three universally accepted methods, that is, those described by Nagata, Brent, and Firmin. These changes, as well as the reasons behind them, were documented.
On objectively measuring and analysing the replication of normal morphologic characteristics of the reconstructed ears, we documented progressive improvement of our results. Good or excellent results could be achieved in 70% of cases in the second group compared to a poor outcome in more than 2/3(rd) of the cases carried out during the initial period. Based on these results and the changes adopted in our practice we propose suggestions for management of microtia cases in the Indian population.
An objective, weighted grading system has further enabled us to critically evaluate the outcomes and to further improve upon the existing results. Our amalgamation of the salient features of the established techniques as well as changes made based on our experience has enabled us to get good results more consistently in our attempts at microtia reconstruction. We believe that the adoption of such amalgamated methods will be more suitable in Indian patients.
拥有所有解剖标志的理想耳朵，是任何着手为小耳畸形患者进行耳部重建的整形外科医生的目标。文献中对技术的描述丰富多样，但主要是针对白种人和东方人群的报道。关于印度次大陆人群手术结果的出版物极少。尽管严格遵循推荐的重建技术，但这些患者所获得的结果常常受到一些在东方或白种人群中未被报道的问题的影响。这可能需要重新审视这些病例的治疗策略。由于缺乏一种标准化的结果评估方法，阻碍了对结果的评估、报告以及对治疗策略改变所带来的改善情况进行审核。因此，我们对一系列接受小耳畸形重建手术的患者进行了尝试，使用一种基于重建耳廓解剖结构既定定义的新工具来评估结果。我们还进一步努力记录了研究期间重建技术执行过程中的修改情况。
对2003年12月至2014年9月在一家三级护理教学医院接受小耳畸形耳部重建手术的44例患者进行回顾性研究，并对11例患者进行前瞻性分析。借鉴永田对“理想重建耳”的描述，即应展现所有解剖结构，我们制定了一个客观的分级系统来评估我们的结果。这些年该技术结合了三种普遍认可的方法（即永田、布伦特和菲尔明所描述的方法）的原则，经历了多次变革。我们记录了这些变革及其背后的原因。
通过客观测量和分析重建耳朵正常形态特征的复制情况，我们记录了结果的逐步改善。与初期超过2/3的病例效果不佳相比，第二组70%的病例能够取得良好或优秀的结果。基于这些结果以及我们在实践中采用的变革，我们对印度人群小耳畸形病例的治疗提出了建议。
一个客观的加权分级系统使我们能够更严格地评估结果，并在现有结果的基础上进一步改进。我们将既定技术的显著特征与基于经验所做的改变相结合，使得我们在小耳畸形重建尝试中能够更一致地获得良好结果。我们认为采用这种融合方法将更适合印度患者。
