Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Plastic and Reconstructive Surgery, Montreal Children's Hospital, 1001 boul. Décarie, Montreal, QC H4A 3J1, Canada; Department of Plastic and Reconstructive Surgery, CHU Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada.
Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom.
J Plast Reconstr Aesthet Surg. 2019 Mar;72(3):498-504. doi: 10.1016/j.bjps.2018.11.006. Epub 2018 Nov 28.
Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication.
All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to September 2012 were retrospectively reviewed to identify any that developed exposure of the underlying cartilage framework. Details related to timing, location, size and management of the cartilage exposure were collected.
From a total of 230 autologous auricular reconstructions (median age at first stage, 11.4 years), 15 exposures of the cartilage framework were identified. All exposures occurred following the first stage of reconstruction (mean of post-operative day 29, range, 7-86 days). Large areas of exposure (> 10 mm2) required surgical management, with debridement and coverage with either a cutaneous or fascial flap, depending on the location. Areas < 10 mm2 were managed conservatively. All exposures were successfully treated with no adverse effects on the final aesthetic outcome.
Cartilage exposure following autologous microtia reconstruction can be a devastating complication if not addressed in a prompt and effective manner. The management strategy we propose provides a concise algorithm to guide the treatment of cartilage exposure.
Therapeutic, grade III.
成功的小耳畸形重建需要制作软骨框架并提供薄而坚韧的软组织覆盖物。如果这种皮肤覆盖物的血管受到影响，可能会导致软骨暴露，导致软骨吸收和最终耳重建形态的变形。我们介绍了处理这种并发症的方法。
回顾性分析了 2006 年 4 月至 2012 年 9 月间由同一位外科医生（NWB）进行自体耳重建的所有患者，以确定任何患者发生了软骨下框架暴露的情况。收集了有关软骨暴露的时间、位置、大小和处理的详细信息。
在总共 230 例自体耳廓重建中（第一阶段的中位年龄为 11.4 岁），发现了 15 例软骨框架暴露。所有暴露均发生在第一阶段重建后（平均术后 29 天，范围为 7-86 天）。大面积暴露（>10mm2）需要手术处理，根据位置选择清创和皮瓣或筋膜瓣覆盖。面积<10mm2 的采用保守治疗。所有暴露均成功治疗，对最终美学效果无不良影响。
如果不及时有效地处理，自体小耳畸形重建后软骨暴露可能是一种破坏性的并发症。我们提出的管理策略提供了一种简洁的算法来指导软骨暴露的治疗。
治疗，III 级。
