Strategy for dealing with failed reconstructed ears

Abstract

Objective To discuss the strategy for dealing with the failed reconstructed ears. Methods From January 2010 to January 2015, 14 cases (14 ears) were admitted to our department because of failed reconstructed ears. It was impossible to improve their appearance greatly just by adjusting the original structures. We had to take out the framework and re-reconstruct the ear with autologous costal cartilages. Depending on the conditions of soft tissue, we divided them into three groups: Group 1, 8 ears(57.1%), the soft tissue could be reused simultaneously after being dealt with appropriately although the original frameworks were distorted badly. We took out the original frameworks, harvested cartilages again, fabricated the new frameworks and wrapped them with the original soft tissue. Group 2, 4 ears(28.6%), the structures were damaged completely, just with the constricted scars and skin graft clinging on the mastoid bone. We wrapped the new framework with axial temporal superficial fascia flap and then covered the wound with skin graft; Group 3, 2 ears(14.3%), the structures were distorted seriously. The skin flap covering the framework constricted badly while the post-auricular fascia flap was unspent. We took out the framework, implanted the skin expander under the spread skin flap, and then re-reconstructed the ear with expansion method. Results 13 of 14 cases( 92.9%)were rebuilt successfully. The new ears maintained the landmark subunits 1 month after surgery. In 1 case (7.1%) from group 3, the creased skin had a rupture during skin expansion period. The expander had been taken out, and then a new one was replaced 3 months later. Follow-up period was 3-12 months. The structures of all the 14 rebuilt ears were stable and much better than before. Conclusions Good results could be achieved when appropriate method was selected for failed reconstructed ear. The condition of soft tissue of distorted reconstructed ear should be considered. Key words: Reconstruction of auricle; Microtia; Costal cartilage; Ear framework; Re-reconstruction