The surface structure of the ear is complex and delicate, and shaping a realistic ear is a very complex and challenging surgery in plastic surgery. The surgical methods include Tanzer-Brent’s staged auricular reconstruction method, one-stage auricular reconstruction method, traditional skin expansion auricular reconstruction method, and fully expanded auricular reconstruction method without skin implants.
I. Brent’s staging method
Generally, there are four stages: Stage I. In the second stage, the rib cartilage is cut and sculpted to form an ear scaffold to be implanted under the skin of the mastoid area, and in the third stage. The cartilage and skin are lifted and the skin is implanted on the dorsal surface of the cartilage. The ear screen and the auricular cavity are reconstructed, each stage is separated by at least three months, and the whole process takes about one year.
Second, one-stage auricular reconstruction method.
The skin of the mastoid area is lifted and the cartilage scaffold is fixed on the cranial side wall. The anterior side of the scaffold is covered with the lifted skin, and the back side is covered with the mastoid area and the temporal fascia and then the skin is implanted, and then appropriate trimming is done according to the situation. The advantage of this method is that it saves time and can be completed in two weeks. The disadvantage is that the skin of the mastoid area is not enough and extends to the back and above with some hair, so that the reconstructed ear is thicker and has hair on the edge of the ear wheel, and more skin needs to be transplanted and the scar of the donor area is obvious. It is rarely used now.
Third, the traditional expansion method of ear reconstruction
Since the skin expansion method of ear reconstruction has many advantages such as adequate skin source, hidden postoperative scar, and stable long-term effect of the reconstructed ear, it is the more commonly used method of ear reconstruction surgery, which generally needs to be completed in three stages.
The first stage is the implantation of a 70-90 ml dilator into the posterior mastoid area, which is done one week after the surgery;
In the second stage of auricular reconstruction, rib cartilage is taken during surgery for sculpting the ear scaffold, and then the expanded skin of the ear is used as the skin of the anterior auricle, and the area behind the ear with insufficient skin still needs to be implanted in order to complete the auricular reconstruction. The hospital stay is about 12-13 days, and the patient is discharged from the hospital to recuperate for about 6-12 months after the surgery. After the reconstructed ear is basically stable and the scar is softened, the third stage of surgery is performed.
Phase III Reconstructive ear revision is based on the completed ear reconstruction, and the earlobe transposition earnail cavity and ear screen reconstruction are performed to make the reconstructed ear more perfect and realistic.
The traditional expansion method, although it can solve the problem of insufficient skin to a certain extent, has obvious shortcomings.
Due to the limited area of the hairless area behind the ear, a smaller expander is usually placed, and the expanded skin is still insufficient;
2. The transplanted skin will shrink significantly in the later stages, so most of the reconstructed ears are closer to the head, and most of the skin has to be cut and implanted behind the ear again in the third stage in order to make the ear stand up.
3. The auricle is easily deformed and the cartilage scaffold is easily pulled and deformed or even broken when the skin shrinks;
4. The scar in the skin extraction area is obvious because the tension of the incision after skin extraction is large, and the scar will become wider and wider with the progress of time after the incision is pulled together and sutured.
IV. Full ear reconstruction by large volume full expansion method
In order to solve the above problem, the team led by me pioneered the auricular reconstruction method that requires no skin implantation for over-expansion of large-capacity expander. The process is roughly similar to the traditional expansion method, that is, a large expander (100-150cc) is implanted behind the ear when the expander is implanted in the first phase, and the second phase is completed by covering the cartilage scaffold surface with expanded skin. Due to the expansion of the large expander, there is no need for skin removal and implantation during the second stage of surgery.
1. No complications of skin grafting There is no possibility of stent exposure after surgery due to poor skin graft survival.
2. The scarring of the donor area is significantly reduced.
3. No scar contraction after the ear because there is no skin graft, so there is very little deformation of the reconstructed ear due to contracture.
4. Good appearance of the reconstructed ear Because no skin graft is needed behind the ear, there is no color difference of the skin graft and no scar around the circumference, and the whole reconstructed ear is more complete and the fine structure is more obvious.
This has been proven to be a practical, aesthetic and safe method of total ear reconstruction. It has been accepted by a wide range of patients and has been well received by patients and their families.