Bacteriolgy before and after total middle ear reconstruction

Objectives To investigate pre-and post-total middle ear reconstruction bacteriological changes in order to facilitate prevention and treatment of surgical infections. Methods Specimens from 128 ears in 124 patients with problematic mastoid cavities who underwent revision total middle ear reconstruction were studied. Results Bacteriological tests were positive in 87(68.0%) pre-operative specimens, despite local treatment, and in 74 (57.8%) specimens collected 10 days after operation. Common organism strains in pre-and post-operative specimens were slightly different and included: coagulase-staphylococcus, GRAM+ rods, staphylococcus aureus, pseudomonas aeruginosa and fungi. At the time of patient discharge(15-20 days post-operative), only 3 ears (2.3%) were tested positive which responded well to and became dry after local treatment. At one year, 4 ears (3.1%) showed recurrent otorrhea which again responded to local treatment. Conclusion For infection of problematic mastoid cavities after an open cavity procedure, revision total middle ear reconstruction is effective in controlling infection and promoting a dry ear. Infection prevention and treatment is important considering the relatively high rates of peri-operative local infections.

Application of Autologous Costal Cartilage Scaffold in Reconstruction of Microtia Ear

Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia reconstruction in our hospital were selected,all of whom were type II or type III pediatric deformities.All patients underwent auricle reconstruction and retroauricular skin expansion and autologous costal cartilage stent.The first stage of the operation is to insert a skin dilator behind the residual ear and inject water to expand.The second stage of the operation is to carve and repair the soft ribs(usually 6 or 7 ribs)from the body,make a three-dimensional auricle support for auricle reconstruction,place a negative pressure drainage tube,and follow up for 3 to 6 months to observe the three-dimensional shape of the reconstructed auricle and the formation of cranioauricular angle.Results 41 patients with microtia had good three-dimensional shape of auricle reconstruction,normal auricle position,moderate cranioauricular angle,good helix and triangular fossa structure,and good bilateral symmetry.Patients and their families were satisfied with the effect of auricle reconstruction.Conclusion Autologous costal cartilage is a good scaffold for auricle reconstruction.It is through efficient and elaborate carving and splicing that a good three-dimensional auricle structure can be formed.Combined with early flap expansion,a good postoperative appearance effect can be obtained,which is the appropriate method for auricle reconstruction at present.

Full retroauricular skin and fascia expansion in microtia reconstruction:a single center experience of 166 cases

Aim:Ear reconstruction is a challenge for plastic and reconstructive surgeons.The ear requires sufficient skin coverage and a three-dimensional(3D)cartilage framework.In this paper,the authors present their 10-year experience in microtia reconstruction using tissue expansion and an autogenous rib cartilage framework.Methods:Ear reconstruction was performed in 3 operative stages.During the first procedure,a 50-80 mL kidney or cylinder-shaped expander was implanted deep to the subcutaneous fascia of the retroauricular mastoid region.Over a period of 3-5 months,the expander was filled to a final volume of 80-110 mL.In the next operation,the retroauricular fascia was eliminated or reserved following expander removal,and the autogenous costal cartilage framework was placed below the expanded skin flap.At the third and final stage,the earlobe transposition,tragus construction and conchal deepening were performed.Results:A total of 165 patients(166 ears)were reconstructed using tissue expansion and an autogenous rib cartilage framework.Complications included hematomas in 3 cases,expander exposure in 8 cases,cartilage exposure in 6 cases,infection and cartilage resorption in 2 cases,exposure of steel wire in 4 cases,and aseptic seroma in 2 cases.Follow-up ranging from 3 months to 5 years showed that 159 patients were satisfied with the reconstructed ear including size,location,projection,convolution,skin-colour matching,symmetry with opposite ear.Conclusion:Expansion of the retroauricular skin and fascia can provide sufficient non-hair-bearing skin and tissue for coverage of a three-dimensional costal cartilage framework.Avoidance and prompt treatment of complications are advised in order to obtain a satisfactory reconstruction of the ear.