Update on Total Auricular Construction | Journal CME Article-Journal CME Article: Update on Total Auricular Construction Article

Journal CME Article: Update on Total Auricular Construction Article

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The document is an extensive review on strategies for total auricular reconstruction, primarily for conditions like microtia where ear structure is absent or malformed. It elaborates on preoperative planning, surgical techniques, and postoperative management for reconstructive surgery of the ear. <br /><br />Key aspects of preoperative planning include an understanding of the normal ear's dimensions and using software tools to map and overlay the "auricular rectangle" to guide incision and construct placement. The text also stresses considering patients' hairline positions as they may influence surgical approaches, particularly those with low hairlines or complex asymmetries such as in cases of hemifacial microsomia. <br /><br />For surgical techniques, the document describes using autogenous methods for skin coverage, frequently using the vestige skin for lobule-type or concha-type microtia to preserve sensation while minimizing the need for skin expanders. In complex reconstructions like anotia, the use of fascias and skin grafts is detailed. Porous polyethylene (PPE) frameworks require complete coverage with a large fascial flap to protect the implant.<br /><br />Surgical preferences in framework construction include using autologous rib cartilage structured into a solid three-dimensional framework or opting for synthetic materials like PPE, tailored to the patient's requirements. Surgeons must decide between these options based on their expertise and specific patient scenarios, as highlighted by contemporary advances and techniques by surgeons such as Nagata and Firmin.<br /><br />The article also covers donor-site reconstruction, emphasizing the preservation of perichondrium to reduce soft rib cage or chest deformities and enabling cartilage regeneration. <br /><br />Additionally, postoperative care is crucial, with meticulous monitoring of skin flaps for signs of ischemia or congestion, implementing dressing techniques, and infection control. Immediate intervention is recommended for complications to prevent further damage or failure of the constructed ear.<br /><br />Overall, this comprehensive guide is intended to help reconstructive surgeons, especially those in their training phases, by offering insights into diverse aspects and techniques in auricular reconstruction surgery.

Keywords

auricular reconstruction

microtia

preoperative planning

surgical techniques

postoperative management

autogenous methods

porous polyethylene

rib cartilage

donor-site reconstruction

Nagata and Firmin