From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2020 Jul;146(1):133-142. doi: 10.1097/PRS.0000000000006906.
Congenital microtia is highly variable in its clinical presentation, leading to many technical modifications to and controversies over treatment. The authors evaluated how surgical revisions and interdisciplinary interventions were involved in microtia reconstruction according to each subtype.
Congenital unilateral microtia patients who underwent two-stage microtia reconstruction from June of 2001 to June of 2019 were reviewed. Patient and surgical variables were collected, including the type, number, and timing of surgical revisions, canaloplasty, and jaw operations. Data were presented in relation to each subtype of microtia (i.e., anotia, small/atypical but usable lobule, typical lobule, concha, and scapha).
From a total of 602 patients, 407 (67.6 percent) underwent some form of revisions and/or interventions in addition to the two stages of microtia reconstruction, with an average number of 2.2. The majority of small/atypical lobule cases underwent revisions to improve aesthetics, with lobule and inferior sulcus as the most problematic regions. Skin flap necrosis, with an overall rate of 4.0 percent, was most commonly found in the concha type. Except for anotia and small/atypical lobule, nearly one-third of all subtypes underwent canaloplasty, necessitating protective strategies against the circulation-threatening condition. A very small number of jaw operations (up to 7 percent) were performed in all subtypes.
Over the two-decade cohort study of microtia reconstruction, revision and interdisciplinary operations were used differently for each subtype. An optimal management plan will be established with respect to type-specific conditions, including the level of difficulty in elevating the subcutaneous pedicle, usable vestige, and later effect of canaloplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
先天性小耳畸形在临床表现上高度多变，导致治疗方法存在许多技术修改和争议。作者根据每种亚型评估了手术修正和跨学科干预如何参与小耳畸形重建。
回顾了 2001 年 6 月至 2019 年 6 月期间接受两阶段小耳畸形重建的先天性单侧小耳畸形患者。收集了患者和手术变量，包括手术修正、耳道成形术和颌骨手术的类型、数量和时间。数据根据小耳畸形的每种亚型（即无耳、小/非典型但可用的耳垂、典型耳垂、耳甲和耳屏）呈现。
在总共 602 名患者中，有 407 名（67.6%）除了接受两阶段小耳畸形重建外，还进行了某种形式的修正和/或干预，平均次数为 2.2 次。大多数小/非典型耳垂病例进行修正以改善美观，耳垂和下皱襞是最成问题的区域。皮肤瓣坏死的总体发生率为 4.0%，最常见于耳甲类型。除无耳和小/非典型耳垂外，几乎所有亚型中有近三分之一进行了耳道成形术，需要采取保护策略以防止循环威胁情况。所有亚型中仅进行了少量的颌骨手术（最高达 7%）。
在 20 年的小耳畸形重建队列研究中，修正和跨学科手术根据每种亚型的不同而有所不同。将根据特定类型的情况制定最佳管理计划，包括皮下蒂提升的难度水平、可用遗迹和后期耳道成形术的效果。
临床问题/证据水平：治疗，IV。
