BACKGROUND: Lobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes.
METHODS: A total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction.
RESULTS: The patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction.
CONCLUSIONS: The prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.

OBJECTIVE: Unilateral costal cartilage harvesting (UCCH) for auricle reconstruction in children tends to cause thoracic deformities. Therefore, our study aimed to develop a novel bilateral costal cartilage harvesting (BCCH) method to prevent and reduce thoracic deformities.
METHODS: Patients with unilateral microtia who underwent either UCCH (n = 50) or BCCH (n = 46) were enrolled in this study. The grafts for the BCCH group were harvested from the 6th costal cartilage of the ipsilateral hemithorax and the 7th and 8th cartilage from the other hemithorax. Computed tomography and physical examination were performed to identify any physical deformities in the chest contours post-surgery. The cosmetic appearance of the thoracic scars post-surgery was evaluated using the Scar Cosmesis Assessment and Rating Scale (SCAR) and Visual Analogue Scales (VAS cosmetic). The numerical rating scale (NRS) was used to quantify the pain in donor sites. The reconstructed ears were assessed during the follow-up period.
RESULTS: None of the patients in the BCCH group developed thoracic deformities, while 16 patients within the UCCH group developed mild (n = 12) or severe (n = 4) thoracic deformities (p < 0.001). The SCAR (3.09 vs. 2.92, p = 0.580) and VAS scores (0.96 vs. 0.90, p = 0.813) did not differ significantly between the two groups. For both treatment arms, the NRS scores were highest on the first-day post-surgery and gradually dropped over the 10 days. No significant differences were found in the NRS scores and the aesthetic outcomes of the reconstructed ears between the two groups.
CONCLUSIONS: The BCCH method effectively reduced the incidence of thoracic deformity at the donor site without increasing postoperative pain and cosmetic concerns for patients. It could be used clinically to improve patient outcomes of costal cartilage grafts.
METHODS: 4 Laryngoscope, 134:3572-3580, 2024.

OBJECTIVE: The traditional Tanzer-Brent method, which uses the integral engraving of costal cartilage, provides insufficient three-dimensional sensation and is characterized by poor firmness of the auricle framework. This tends to cause the absorption deformation of the auricle framework after surgery. In order to reduce the absorption deformation as well as make the reconstructed auricle more three-dimensional and the ear shape more realistic, our ear reconstruction team invented a novel method to make an auricle framework with autologous costal cartilage. The auricle framework made by this novel method has been applied to auricle reconstruction and has achieved excellent surgical results.
METHODS: Clinical data and postoperative data were collected for patients with unilateral microtia who received auricle reconstruction using the novel method of auricle framework construction in Plastic Surgery Hospital from January 2020 to June 2022. The therapeutic effect of this novel method was evaluated by the satisfaction rate of patients and their families and by the prevalence of postoperative complications.
RESULTS: A total of 60 patients were enrolled in this study. The average age was (10.95 ± 2.97) years old. The mean follow-up time was 24.02 ± 1.52 months. The satisfaction rate of patients and their families was 96.7%. In terms of postoperative complications, two patients had postoperative infection, one patient had framework exposure, no patients had framework absorption and deformation, two patients had postoperative hematoma, and three patients had scar hyperplasia.
CONCLUSIONS: This novel method of making the auricle framework is more standardized, easier to master for plastic surgeons, and more conducive to the clinical application of plastic surgery. Through this study, we believe that this novel method offers significant therapeutic advantages and can be used as a unified standard for construction of an auricle framework using autologous costal cartilage.

High-density polyethylene (HDPE) is a promising material for the development of scaffold implants for auricle reconstruction. However, preparing a personalized HDPE auricle implant with favorable bioactive and antibacterial functions to promote skin tissue ingrowth is challenging. Herein, we present 3D-printed HDPE auricle scaffolds with satisfactory pore size and connectivity. The layer-by-layer (LBL) approach was applied to achieve the improved bioactive and antibacterial properties of these 3D printed scaffolds. The HDPE auricle scaffolds were fabricated using an extrusion 3D printing approach, and the individualized macrostructure and porous microstructure were both adjusted by the 3D printing parameters. The polydopamine (pDA) coating method was used to construct a multilayer ε-polylysine (EPL) and fibrin (FIB) modification on the surface of the 3D HDPE scaffold via the LBL self-assembly approach, which provides the bioactive and antibacterial properties. The results of the in vivo experiments using an animal model showed that LBL-coated HDPE auricular scaffolds were able to significantly enhance skin tissue ingrowth and ameliorate the inflammatory response caused by local stress. The results of this study suggest that the combination of the 3D printing technique and surface modification provides a promising strategy for developing personalized implants with biofunctional coatings, which show great potential as a scaffold implant for auricle reconstruction applications.

OBJECTIVE: We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators.
METHODS: The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched.
RESULTS: The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 3.2% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 2.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 3.1% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis (P > .05).
CONCLUSIONS: The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.

UNASSIGNED: The anterior surface of the auricle is especially susceptible to a variety of traumatic insults and cutaneous malignancies. However, given the unique anatomy of this structure and the lack of local tissue available, the reconstruction of these defects is still a challenge. Despite of their positive outcomes, tunneled flaps have not been thoroughly explored in the literature.
UNASSIGNED: To review the clinical utility of tunneled flaps in reconstructing anterior auricle defects.
UNASSIGNED: A review of the literature on surgical reconstruction of the anterior auricle surface was performed in PubMed, with specific reference to tunneled flaps.
UNASSIGNED: When designed and executed properly, tunneled flaps offer unrivalled opportunities to reconstruct anterior auricle defects, with maximal preservation of the symmetry.

OBJECTIVE: Patients with microtia and aural atresia have multiple options for treatment of conductive hearing loss (CHL) and auricle reconstruction; however, little is known about the factors influencing treatment selection. This study aims to review the socioeconomic and clinical data of microtia/atresia patients to evaluate congruency with national data and whether these factors affect treatment decisions.
METHODS: Retrospective review of patients evaluated in the microtia and atresia multidisciplinary clinic (MDC) at a tertiary academic children\'s hospital between 2008 and 2018. Outcomes included demographic, socioeconomic and clinical factors associated with hearing surgery and framework surgery.
RESULTS: 373 patients were seen in the Microtia MDC: 193 (51.7%) were male, 187 (50.1%) identified as Hispanic and 23 (6.2%) identified as Asian. 267 (75.6%) patients received a nonsurgical bone conduction hearing device (BCHD); fitting at a younger age was associated with better nonsurgical BCHD compliance. Multivariate analysis was performed on the patients that were eligible for surgery based on age and appropriate follow-up. 70 (18.8%) patients had placement of an osseointegrated BCHD; inconsistent compliance with nonsurgical BCHD decreased the odds of proceeding with osseointegrated BCHD placement. 60 (16.1%) patients underwent framework surgery for external reconstruction. Placement of osseointegrated BCHD was the only factor that was associated with proceeding with framework surgery. Other assessed demographic and socioeconomic factors were statistically not associated with selection of surgical intervention.
CONCLUSIONS: Fitting a nonsurgical BCHD at a younger age is associated with higher likelihood of nonsurgical BCHD compliance, that is in turn associated with patients and families proceeding with osseointegrated BCHD and framework surgery.

To confirm the advantage of 3D template over the traditional 2D template in auricle reconstruction. Two hundred patients with Marx III unilateral microtia treated in our hospital during the last four years were included in this retrospective study. They were divided into two groups according to the surgery which was assisted by 2D or 3D template. The outcome was evaluated 6 months after the surgery in the following aspects: the mean surgical time, the similarity rate for ear size, nasal-tip to tragus length and auriculocephalic angle, the patient\'s satisfaction and the quality of life after surgery. The surgical time for the 3D group was 3.2 ± 1.9 hours, significantly shorter than that for the 2D group (4.1 ± 3.7 hours; P < 0.05). The similarity rates between both sides were 91.24 ± 1.71%, 96.46 ± 2.51%, and 88.15 ± 10.20% respectively for ear size, nasal tip-tragus length, and auriculocephalic angle in the 3D group. While the corresponding values in the 2D group were smaller and were 87.47 ± 3.66%, 90.16 ± 3.27%, and 78.25 ± 1.26% respectively. The difference was significant in nasal tip-tragus length and auriculocephalic angle (P < 0.05), but not for ear size (P > 0.05). The patients\' satisfaction was better in the 3D group. The averaged GCBI score was 65.6 ± 13.2 in the 3D group, which was significantly higher than the value of 55.3 ± 16.8 in the 2D group (P < 0.05). The use of 3D template resulted in a better outcome in the auricle reconstruction surgery.

The aim of this study was to assess whether modified bacterial cellulose can be used for an artificial auricle skeleton.
BACKGROUND: The auricle is a part of the external ear. It consists of skin, cartilage, muscles and adipose tissue. The cartilage gives shape to the structure. There are several indications for reconstruction, such as congenital anomalies, mechanical injuries, and burns, and a range of methods have been proposed for the complete reconstruction of the auricle.
METHODS: A bacterial cellulose membrane, at least 25 mm in thickness, was produced in vitro by Acetobacter xylinum culture. The entire artificial human auricle skeleton was made to scale to allow its implantation into an animal model - Wistar rats. Forty rats were divided into four groups of 10 animals. Each group was assigned a different resection time: 14 days, 30 days, 90 days or 720 days. After each resection, an examination of the artificial skeleton and the tissues surrounding it was conducted. The surgical procedure was based on the Nagata technique.
RESULTS: Resection after 14, 30, 90 and 720 days shows the progression of the healing process and integration of the artificial skeleton into the animal body. There are no signs of change in the shape or structure of the skeleton.
CONCLUSIONS: Several surgical techniques and biotechnological methods have been developed over the past few years to improve the results of facial reconstruction. Other approaches can be used to create auricle cartilage, based on scaffolds and chondrocytes.
CONCLUSIONS: My findings indicate that modified bacterial cellulose can be used to form an effective artificial auricle which appears to maintain its shape and elasticity, with no signs of degradation.

BACKGROUND: A transcutaneous bone-conduction hearing device (tBCHD), the Baha Attract System has been recently introduced to China, and very few studies have assessed the efficacy of this system in speakers of mandarin.
OBJECTIVE: This study aims to analyze the functional and cosmetic outcomes of this system.
METHODS: This prospective study included 11 patients (nine males, two females), of mean age 16 years (range 9-32 years). Seven patients were conducted the implantation simultaneously with auricle reconstruction, and the other four were before it. Auditory results were compared between unaided patients and implanted patients. Subjective satisfaction was analyzed using three questionnaires.
RESULTS: The mean sound field thresholds were 65.9 ± 5.1 dB SPL unaided and 30.9 ± 4.7 dB SPL with an implanted Baha Attract System, resulting in a mean hearing gain of 35.0 ± 6.7 dB. The mean WRS scores were 47.8 ± 8.7% unaided and 92.1 ± 2.0% with the Baha Attract System, resulting in a mean improvement of 47.8 ± 8.7%. No adverse events were reported and questionnaires showed good patients satisfaction.
CONCLUSIONS: The transcutaneous Baha Attract System is effective in mandarin speaking patients, and the combination of hearing rehabilitation and auricle reconstruction surgery is promising for patients with bilateral microtia-atresia.