Sharma Mohit, G Srilekha Reddy, Kongara Shruti, Jain Vasundhara, K S Shravan Rai, Harijee Ankita, Badam Abhinandan, Maharaja Nirav G, Joseph Thomas, R Janarthanan, Iyer Subramania
Department of Plastic and Reconstructive Surgery, Amrita Hospital, Faridabad, Haryana, India.
Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Plast Surg. 2023 Feb 28;56(2):130-137. doi: 10.1055/s-0043-1762907. eCollection 2023 Apr.
: Autologous costal cartilage framework placement is currently the gold standard in patients with microtia. In this article, we present the modifications developed by the author, generally following the principles established by Nagata, and discuss the technical details that have led us to achieve consistently stable and good long-term outcomes for auricular reconstruction in microtia. : A retrospective review of microtia reconstruction performed from 2015 to 2021 was done. Those who underwent primary reconstruction for microtia and with a minimum follow-up of 6 months with documented photographs were included. Those who underwent secondary reconstruction for microtia and those who did not follow-up for a minimum period of 6 months were excluded. Outcomes were assessed with regard to appearance, and durability of the result. Influence of certain changes like delaying reconstruction until 15 years of age, use of nylon for framework fabrication, etc. over the outcome were assessed. : Of 11 ears reconstructed at less than 15 years of age, only one patient (9%) had a good long-term outcome, whereas of the 17 ears reconstructed at greater than 15 years of age, nine patients (53%) had a good long-term outcome. In our experience, infections and wire extrusions were the significant events related to severe cartilage resorption. : In our experience, delaying the first stage to 15 years or later, using double-armed nylon sutures, and reducing the projection of the third layer of the framework in select cases have helped to improve our outcomes. Second stage of reconstruction can be avoided if patient is satisfied with the projection achieved in the first stage.
自体肋软骨支架植入目前是小耳畸形患者的金标准。在本文中，我们介绍了作者所做的改进，总体上遵循了Nagata确立的原则，并讨论了使我们在小耳畸形耳廓重建中始终获得稳定且良好长期效果的技术细节。
对2015年至2021年进行的小耳畸形重建手术进行了回顾性研究。纳入那些接受小耳畸形一期重建且随访至少6个月并有记录照片的患者。排除那些接受小耳畸形二期重建的患者以及随访时间不足6个月的患者。从外观和结果的持久性方面评估结果。评估了某些改变（如将重建推迟到15岁、使用尼龙制作支架等）对结果的影响。
在15岁以下重建的11只耳朵中，只有1例患者（9%）获得了良好的长期效果，而在15岁以上重建的17只耳朵中，有9例患者（53%）获得了良好的长期效果。根据我们的经验，感染和钢丝外露是与严重软骨吸收相关的重要事件。
根据我们的经验，将第一阶段推迟到15岁或更晚、使用双臂尼龙缝线以及在某些情况下减少支架第三层的突出度有助于改善我们的手术效果。如果患者对第一阶段获得的突出度满意，则可以避免第二阶段的重建。
