Reconstructive Plastic Surgery For Auricular Defects

Abstract

Objective – To improve the results of surgical treatment of various defects of the auricle by improving the methods of otoplasty.

Material and Methods - The study included patients with acquired traumatic defects and III degree inborn folded auricle. The work was carried out in the Department of Plastic and Reconstructive Microsurgery of the State Institution " RSSPMCS named after Academician V. Vakhidov" for the period from 1990 to 2020. In general, the comparative analysis of the results included 38 patients in the main group, among them in 13 (34.2%) cases there were defects with extension to the central part of the auricle, 15 (39.5%) patients with III degree deformity of the auricle (folded auricle), as well as in 9 cases - marginal defects of the auricle and in 1 case a patient with a total traumatic defect. The comparison group included 28 patients, 16 (57.1%) - defects with extension to the central part of the auricle and 12 (42.9%) patients with III degree deformity of the auricle. Accordingly, the effectiveness of the proposed otoplasty method for ear defects was assessed according to two categories of pathologies - defects with extension to the central part of the auricle and grade III ear deformity (folded auricle). The average age in the main group was 22.4 ± 1.3 years, in the comparison group 19.4 ± 1.9 years.

Results - Improved methods of reconstruction of an amputated but preserved auricle, with a peripheral defect of the auricle, with a folded auricle, and reconstructive otoplasty with defects with the capture of the central parts of the auricle are proposed. In total, complications developed in 8 (29.6%) patients in the comparison group and 2 (7.1%) in the main group. At the same time, the incidence of surgical complications, which subsequently led to the need for re-reconstruction, was 11.1% in the comparison group. There were no complications in the main group. In total, 6 (22.2%) additional stages of otoplasty were performed in the comparison group. In the main group, an additional stage of surgery was required only in 1 (3.6%) case of the formation of an unnatural skin fold. There was also a statistically significant difference in the number of additional plastic surgery stages performed for the complications noted above (criterion χ2 = 4.305; df = 1; p = 0.039). The average duration of surgery in the comparison group for all stages of reconstructive otoplasty was 220.7 ± 2.7 minutes, and in the main group after 2-stage otoplasty according to the proposed method - 189.5 ± 1.9 minutes (t-criterion = -9 , 60; p <0.05).

Conclusion - The improved method of otoplasty in case of grade III defects or deformities of the auricle made it possible to reduce the overall incidence of complications from 29.6% to 7.1%, and to reduce the need for repeated reconstructive interventions from 22.2% to 3.6%, which, in general, led to a decrease in the period of complete rehabilitation from 4.4 ± 0.1 to 3.7 ± 0.1 months.