Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Facial Plast Surg Aesthet Med. 2020 Nov/Dec;22(6):456-463. doi: 10.1089/fpsam.2020.0144. Epub 2020 Sep 1.
Resorption of the cartilage framework results from hematoma or infection, deteriorating outcomes in microtia reconstruction. Delayed resorption still occurs for unclear reasons in patients without adverse events. The risk factors for delayed framework resorption were explored in this 20-year microtia cohort. Patients who underwent auricular elevation >5 years ago were reviewed from January 2001 to March 2019. Bilateral microtia, infection, and hematoma cases were excluded. Framework resorption was graded on the last photographs as none to minimal (grade 1), blunted but all components present (grade 2), loss of either the helical or antihelical component (grade 3), and loss of all components (grade 4). Logistic regression was used to evaluate independent risk factors for grade 3 and 4 resorption. Of the 367 patients, 132 revisited our institution with a mean postoperative duration of 8.0 years. Grade 1 resorption was seen in 37.1%, 2 in 31.8%, 3 in 24.2%, and 4 in 6.8%. Canalplasty increased the risk of resorption regardless of timing (before auricular elevation, = 0.017; after auricular elevation, = 0.011). Body mass index at the time of cartilage harvest lowered the risk of resorption ( = 0.057) with clinical significance. Canalplasty may be avoided given the risk of framework resorption or may be performed with antiresorption strategies if the expected hearing outcome is superior. Our timing of harvest at the age of 10 years may have ensured cartilage maturation, both in terms of size and biomechanics, resulting in the resistance to resorption.
软骨框架的吸收是由血肿或感染引起的，这会恶化小耳畸形重建的结果。在没有不良事件的患者中，仍不明原因地发生延迟吸收。本研究旨在探讨这一长达 20 年的小耳畸形队列中延迟框架吸收的危险因素。从 2001 年 1 月至 2019 年 3 月，回顾了过去 5 年以上行耳廓抬高术的患者。排除双侧小耳畸形、感染和血肿病例。根据最后一次照片将框架吸收分级为无至轻度（1 级）、钝但所有成分均存在（2 级）、螺旋或反螺旋结构之一缺失（3 级）和所有成分缺失（4 级）。使用逻辑回归评估 3 级和 4 级吸收的独立危险因素。在 367 例患者中，有 132 例患者在术后 8.0 年时复诊，1 级吸收占 37.1%，2 级占 31.8%，3 级占 24.2%，4 级占 6.8%。无论时机如何，耳甲腔成形术都会增加吸收的风险（耳廓抬高前，=0.017；耳廓抬高后，=0.011）。软骨采集时的体重指数降低了吸收的风险（=0.057），具有临床意义。考虑到框架吸收的风险，可能需要避免耳甲腔成形术，或者如果预期听力效果较好，可能需要使用抗吸收策略。我们在 10 岁时进行软骨采集的时机可能确保了软骨的成熟度，无论是在大小还是生物力学方面，这使得软骨不易吸收。
