Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are equally important factors which influence donor-site deformity in microtia reconstruction.
References
[1]
Du, J.M., Chai, J.K., Zhuang, H.X., et al. (2008) An Investigation of Psychological Profiles and Risk Factors in Congenital Microtia Patients. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61, S37-S43. https://doi.org/10.1016/j.bjps.2007.09.002
[2]
McDowell, F. (1969) The Classic Reprint. Ancient Ear-Lobe and Rhinoplastic Operations in India. Plastic and Reconstructive Surgery, 43, 515-522.
[3]
Tagliacozzi, G. (1597) De Curtorum Chirurgia per Institionem. Gaspare Bindonus.
Ely, E.T. (1968) An Operation for Prominence of the Auricles. Plastic and Reconstructive Surgery, 42, 582-583. https://doi.org/10.1097/00006534-196812000-00012
[6]
Gillies, H.D. (1920) Plastic Surgery of the Face Based on Selected Patients of War Injuries of the Face Including Burns with Original Illustrations. H. Frowde.
[7]
Tanzer, R.C. (1959) Total Reconstruction of the External Ear. Plastic and Reconstructive Surgery, 23, 1-15. https://doi.org/10.1097/00006534-195901000-00001
[8]
Tanzer, R.C. (1971) Total Reconstruction of the Auricle: The Evolution of a Plan of Treatment. Plastic and Reconstructive Surgery, 47, 523-533. https://doi.org/10.1097/00006534-197106000-00001
[9]
Brent, B. (1980) The Correction of Microtia with Autogenous Cartilage Grafts. I. The Classic Deformity. Plastic and Reconstructive Surgery, 66, 1-12. https://doi.org/10.1097/00006534-198007000-00001
[10]
Brent, B. (1980) The Correction of Microtia with Autogenous Cartilage Grafts. II. Atypical and Complex Deformities. Plastic and Reconstructive Surgery, 66, 13-21. https://doi.org/10.1097/00006534-198007000-00002
[11]
Brent, B. (1987) Total Auricular Construction with Sculpted Costal Cartilage. The Artistry of Reconstructive Surgery. Mosby, 113.
[12]
Microtie, F.F. (1992) Reconstruction par la technique de Brent. Annales de Chirurgie Plastique et Esthétique, 37, 119-131.
[13]
Fukuda, O. (1974) The Microtic Ear: Survey of 180 Patients in 10 Years. Plastic and Reconstructive Surgery, 53, 458-463. https://doi.org/10.1097/00006534-197404000-00014
[14]
Tanzer, R.C. (1963) An Analysis of Ear Reconstruction. Plastic and Reconstructive Surgery, 31, 16-30. https://doi.org/10.1097/00006534-196301000-00003
[15]
Nagata, S. (1994) Modification of the Stages in Total Reconstruction of the Auricle: Part I. Crating the Three-Dimensional Costal Cartilage Framework for Lobule-Type Microtia. Plastic and Reconstructive Surgery, 93, 221-230. https://doi.org/10.1097/00006534-199402000-00001
[16]
Nagata, S. (1994) Modification of the Stages in Total Reconstruction of the Auricle: Part II. Grafting the Three-Dimensional Costal Cartilage Framework for Concha-Type Microtia. Plastic and Reconstructive Surgery, 93, 231-242. https://doi.org/10.1097/00006534-199402000-00002
[17]
Nagata, S. (1994) Modification of the Stages in Total Reconstruction of the Auricle: Part III. Grafting the Three-Dimensional Costal Cartilage Framework for Small Concha-Type Microtia. Plastic and Reconstructive Surgery, 93, 243-253. https://doi.org/10.1097/00006534-199402000-00003
[18]
Nagata, S. (1994) Modification of the Stages in Total Reconstruction of the Auricle: Part IV. Ear Elevation for the Constructed Auricle. Plastic and Reconstructive Surgery, 93, 254-266. https://doi.org/10.1097/00006534-199402000-00004
[19]
Brent, B. (1981) A Personal Approach to Total Auricular Construction: Case Study. Clinics in Plastic Surgery, 8, 211-221. https://doi.org/10.1016/s0094-1298(20)30447-8
[20]
Brent, B. (1974) Ear Reconstruction with an Expansile Framework of Autogenous Rib Cartilage. Plastic and Reconstructive Surgery, 53, 619-628. https://doi.org/10.1097/00006534-197406000-00001
[21]
Brent, B. (1975) Reconstruction of Ear, Eyebrow, and Sideburn in the Burned Patient. Plastic and Reconstructive Surgery, 55, 312-317. https://doi.org/10.1097/00006534-197555030-00007
[22]
Osorno, G.M.D. (1999) Autogenous Rib Cartilage Reconstruction of Congenital Ear Defects: Report of 110 Cases with Brent’s Technique. Plastic and Reconstructive Surgery, 104, No. 7. https://doi.org/10.1097/00006534-199912000-000011951-1962
[23]
Weerda, H. and Siegert, R. (1998) Classification of Auricular Malformations. Auricular and Middle Ear Malformations, Ear Defects and Their Reconstruction.
[24]
Tanzer, R.C. (1978) Microtia—A Long-Term Follow-Up of 44 Reconstructed Auricles. Plastic and Reconstructive Surgery, 61, 161-166. https://doi.org/10.1097/00006534-197802000-00001
[25]
Thomson, H.G., Kim, T. and Ein, S.H. (1995) Residual Problems in Chest Donor Sites after Microtia Reconstruction: A Long-Term Study. Plastic and Reconstructive Surgery, 95, 961-968. https://doi.org/10.1097/00006534-199505000-00002
[26]
Ohara, K., Nakamura, K. and Ohta, E. (1997) Chest Wall Deformities and Thoracic Scoliosis after Costal Cartilage Graft Harvesting. Plastic and Reconstructive Surgery, 99, 1030-1036. https://doi.org/10.1097/00006534-199704000-00017
[27]
Brent, B. (1977) The Acquired Auricular Deformity: A Systematic Approach to Its Analysis and Reconstruction. Plastic and Reconstructive Surgery, 59, 475-485. https://doi.org/10.1097/00006534-197704000-00001
[28]
Kawanabe, Y. and Nagata, S. (2006) A New Method of Costal Cartilage Harvest for Total Auricular Reconstruction: Part I. Avoidance and Prevention of Intraoperative and Postoperative Complications and Problems. Plastic and Reconstructive Surgery, 117, 2011-2018. https://doi.org/10.1097/01.prs.0000210015.28620.1c
[29]
Laurie, S.W.S., Kaban, L.B., Mulliken, J.B. and Murray, J.E. (1984) Donor-Site Morbidity after Harvesting Rib and Iliac Bone. Plastic and Reconstructive Surgery, 73, 933-938. https://doi.org/10.1097/00006534-198406000-00014
[30]
Skouteris, C.A. and Sotereanos, G.C. (1989) Donor Site Morbidity Following Harvesting of Autogenous Rib Grafts. Journal of Oral and Maxillofacial Surgery, 47, 808-812. https://doi.org/10.1016/s0278-2391(89)80038-2
[31]
Brent, B. (1992) Auricular Repair with Autogenous Rib Cartilage Grafts: Two Decades of Experience with 600 Patients. Plastic and Reconstructive Surgery, 90, 355-374. https://doi.org/10.1097/00006534-199209000-00001
[32]
Brent, B. (2002) Microtia Repair with Rib Cartilage Grafts. Clinics in Plastic Surgery, 29, 257-271. https://doi.org/10.1016/s0094-1298(01)00013-x
[33]
Brent, B. (1999) Technical Advances in Ear Reconstruction with Autogenous Rib Cartilage Grafts: Personal Experience with 1200 Cases. Plastic and Reconstructive Surgery, 104, 335-338. https://doi.org/10.1097/00006534-199908000-00002
[34]
Kawanabe, Y. and Nagata, S. (2007) A New Method of Costal Cartilage Harvest for Total Auricular Reconstruction: Part II. Evaluation and Analysis of the Regenerated Costal Cartilage. Plastic and Reconstructive Surgery, 119, 308-315. https://doi.org/10.1097/01.prs.0000244880.12256.7c
[35]
Zhang, Q., Quan, Y., Su, Y., Shi, L., Xie, Y. and Liu, X. (2010) Expanded Retroauricular Skin and Fascial Flap in Congenital Microtia Reconstruction. Annals of Plastic Surgery, 64, 428-434. https://doi.org/10.1097/sap.0b013e3181b0bb7e
[36]
Tanzer, R.C. (1987) The Correction of Microtia. In: Burt, B., Ed., The Artistry of Reconstructive Surgery, Mosby, 93-98.
[37]
Nagata, S. (1993) A New Method of Total Reconstruction of the Auricle for Microtia. Plastic and Reconstructive Surgery, 92, 187-201. https://doi.org/10.1097/00006534-199308000-00001
[38]
Thomson, H.G. and Winslow, J. (1989) Microtia Reconstruction: Does the Cartilage Framework Grow? Plastic and Reconstructive Surgery, 84, 908-915. https://doi.org/10.1097/00006534-198912000-00007
[39]
Netscher, D.T. and Peterson, R. (1990) Normal and Abnormal Development of the Extremities and Trunk. Clinics in Plastic Surgery, 17, 13-21. https://doi.org/10.1016/s0094-1298(20)31263-3
[40]
Steindler, A. and Thomas, C.C. (1955) The Mechanism of Respiration. Introduction and Definition. Kinesiology of the Human Body. C.C. Thomas.
[41]
Snellman, O. (1973) Growth and Remodelling of the Ribs in Normal and Scoliotic Pigs. Acta Orthopaedica Scandinavica, 44, 1-91. https://doi.org/10.3109/ort.1973.44.suppl-149.01
[42]
Roy, E.W. and Sarmat, B.G. (1956) Growth in Length of Rabbit Ribs at Costochondral Junction. Surgery, Gynecology and Obstetrics, 103, 481-486.
