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Objective: To summarize the principles of ear reconstruction after rupture of postauricular expanded flap., Methods: The rupture of the postauricular expanded flap was graded as I-IV degree. For flap rupture of I and II degree, the ear reconstruction was performed immediately with autogenous cartilage framework. For flap rupture of III degree, topical and systemic treatment should be done to relieve the redness and swelling. Then the ear reconstruction was performed. For flap rupture of IV degree, the expanded postauricular flap was smoothened. Ear reconstruction was performed 3 months later., Results: There were 67 cases with flap rupture, including 43 cases as I and II degree, 17 cases as III degree and 7 cases as IV degree. Ear reconstruction with autogenous cartilage framework was performed in 43 cases, with Medpor framework in 17 cases. Flap smoothing and secondary ear reconstruction with autogenous cartilage framework was performed in 7 cases. The results were satisfactory with complications in 4 cases (7%), which resolved after treatment. Primary healing was achieved in all the patients., Conclusions: Good result could be achieved in ear reconstruction, even after flap rupture. Proper treatment should be adopted according to the rupture degree.

Objective: To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery., Methods: From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured., Results: The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group., Conclusions: According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.

Objective: To explore the surgical treatment and pathologic mechanism of polyotia., Methods: The operative methods for polyotia were flexible. The main procedures were aimed at the remodeling of tragus with the redundant tissue. Tissue transplantation was used to correct the depression deformity. Compound auricular tissue transplantation and Z-plasty were used for correction of the malformation at the posterior part of polyotia., Results: From 2003 to 2008, 9 patients with polyotia were treated. The tragus was reconstructed after resection of redundant tissue. The depression deformity was corrected with tissue infilling in 6 cases. The compound auricular tissue transplantation was performed in 4 cases. Z-plasty at the lower ear lobe was performed in 2 cases. The appearance and the location of the reconstructed ears looked symmetric to the healthy ear., Conclusions: Natural and symmetric appearance of reconstructed ear can be achieved in polyotia. The abnormal migration of neural crest cell might be the pathologic mechanism of polyotia.

Objective: To explore the application of tissue expander in ear reconstruction and to deal with the complications., Methods: 50 ml kidney-shape tissue expanders were implanted subcutaneously in the mastoid area. The drainage tube was removed 3 days after operation. The suture was removed 10 days later. Since 7 days after operation, 5 ml NS was injected into the expander every time, three times a week. The total injection volume was about 60 ml. After that, the expander was maintained for one month., Results: From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 expander. After the maintaining period, the expanded skin was thin and well-vascularized. The complication rate was 7.79%, including hematoma, malunion and infection., Conclusions: The quantitative tissue expansion is easily manipulated with few complications. It can provide hairless, thin skin with reliable blood supply for ear reconstruction.

Objective: To explore the application of the remnant in repairing the reconstructed ear in microtia., Methods: From October 2000 to July 2006, 1,823 patients with reconstructed ear underwent the second operation for repairing. The remnants were used to reconstruct tragus, antitragus, crus of helix, concha cavum, or relax the adhesion between the reconstructed auricle and cranio wall, or insert into the reconstructed lobule or under the basement of the costal cartilage frame to restore the cranio-auricular angle or to the preauricular subcutaneous to correct the facial local depression., Results: In 1,823 cases, the tragus, antitragus and concha cavum was reconstructeded by remnant auricle in 1,180 cases; helix crus was repaired by remnant auricle in 743 cases; the wound was repaired by remnant auricle flap resulted from relaxing the adhesion between the reconstructed auricle and cranial wall in 68 cases; Subcutaneous and cartilage flap was formed and transferred in 95 cases, and among them the flap was transferred under the basement of the frame to restore the cranio-auricular angle in 77 cases and was transferred to the preauricular subcutaneous to correct the facial local depression in 18 cases; the skin flap was formed by remnant auricle to repair the lobule in 37 cases. All flaps survived completely. The appearance of reconstructed ear was satisfied., Conclusion: The remnant is very useful in repairing the reconstructed ear in microtia. It should be preserved propriately in auricular reconstruction.

Objective: To explore the fabrication and application of three-dimensional autogenous cartilage framework in auricular reconstruction., Methods: The process of fabrication of three-dimensional cartilage framework consisted of cartilage harvesting, carving and assembling the cartilage. The rib cartilage was harvested separately. The three-dimensional framework was composed of three main parts:the helix, the base and the pad, at different layer. The framework was fabricated according to the development of rib cartilage and contour and height of the reconstructed ear., Results: From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 autogenous cartilage frameworks., Conclusions: The three-dimensional framework is easily manipulated. The reconstructed ears look natural and had an erect contour. This method can effectively use the cartilage.

Objective: To investigate the indication and results of three methods for total ear reconstruction., Methods: 960 cases of total ear defect were treated with skin expansion and autogenous rib cartilage framework (n = 786), or skin expansion and Medpor framework (n = 150), or ear prosthesis (n = 24). The indication and results of the three methods were analysed., Results: Good cosmetic results were achieved with all three methods. Autogenous rib cartilage framework was suitable for patients under 30 years old with unaffected skin at mastoid region. Medpor framework was good for grown-up, especially over 30 years old, or with mild infection at mastoid region. Patients with severe skin injury at mastoid region or unwilling to accept surgery should choose ear prosthesis., Conclusions: Satisfactory results can be achieved with suitable methods for total ear reconstruction.

Conclusions: Improved appearance and hearing and increased efficiency are achievable for congenital microbia with defects of external auditory meatus (EAM) and middle ear. First the site of the external auditory meatus (EAM) orifice must be located according to the results of the temporal CT scan, then the auricle can be reconstructed employing the three-stage method. At the third stage, the EAM and middle ear can be reconstructed at the same time., Objective: To select the best approach for reconstruction of congenital microtia with defects of the EAM and middle ear., Patients and Methods: This study analyzed 498 cases (528 ears) of auricle reconstruction by the three-stage method and 77 cases (91 ears operation/120 ears) of EAM and middle ear reconstruction., Results: For auricular reconstructions, the effects of reconstructed auricles were classified into four grades according to their structure verisimilitude and the bilateral symmetry. The majority of patients/families were satisfied. For 52 ears with normal movement of stapes, reconstructions of EAM and middle ear improved hearing by 15-50 dB, but long-term improvement was not ideal. In bilateral patients, 20 of 24 ears with reconstructed EAMs exhibited relapse of stenosis or atresia. For patients whose EAMs were reconstructed first, scar developed around the orifice and affected the skin flap and later auricle reconstruction, while reconstructing the auricle first sometimes resulted in the location of the EAM orifice deviating from an ideal position.

Objective: To investigate the possibility of external ear reconstruction using expanded postauricular scar flap and Medpor framework in burn cases., Methods: External ear reconstruction using expanded postauricular scar flap in combination with Medpor framework was performed in 17 cases whose ear had burn injury., Results: Of the 17 cases, 15 cases achieved success; 2 cases experienced partial exposure of the framework due to inadequate wrapping of the subcutaneous fascia flap and later injury. The longest follow-up was three years, and the final result was satisfactory., Conclusions: External ear reconstruction using expanded postauricular scar flap in combination with Medpor framework is a reliable method for adult (over 25 years) who has ear defect from burn injury.

Objective: To classify and repair "Butterfly Ear" deformity which presents characters of dysplasia of inferior auricle of ear and congenital bat ear., Method: The repairment procedures include: type I: auricular cartilage flap inversion folding technique. type II: local ear skin flap. type III: soft tissue expander autogenous, rib cartilage framework., Results: The method was used in 19 cases from October 2001 to March 2005. Postoperative follow-up showed satisfactory results in all cases., Conclusion: According to "Butterfly Ear" deformity classification, different technique could be applied.

Objective: To explore surgical procedure of congenital microtia., Methods: Ear reconstruction was made using soft tissue skin expander and autogenous rib cartilage framework., Results: Long time follow-up showed that the flap of reconstructed ear was ruddy, soft, with normal sensory function; cartilage framework had no degeneration, absorption and deformation. In addition, the reconstructed ears were coincidence with the normal side on location, form and dimension., Conclusions: It was a good method for congenital microtia to use soft tissue skin expander together with autogenous rib cartilage framework at present time.

Objective: A simple and effective therapy for single side constricted ear., Methods: Transplanting normal side free composite auricular grafts to constricted ear (15 patients and 15 sides), then lengthening the helix, exposing the scapha, correcting deformity., Results: The 15 patients composite grafts all survived. The helix has been lengthened, the scapha exposed, the normal ear reduced, the constricted ear augmented and two sides ear have become symmetry., Conclusion: This method is simple and results are satisfied.

The one-stage total ear reconstruction (auricular reconstruction and tympanoplasty) has a number of merits. 1. Satisfactory esthetic results obtained in one operation. 2. The "super thin" skin flap is elevated on a plane that excludes hair follicles from the flap, so the hair-bearing areas of the scalp can be readily incorporated as part of the ear reconstruction. 3. The reconstructed ear has adequate blood supply and protective sensation. 4. The surgeon may choose to carry out a tympanoplasty and obtain restoration of auditory function or may choose to carry out a pseudomeatus procedure and reduce the operating time. We feel that the "super thin" skin flap and the simultaneous tympanoplasty are valuable supplements to ear reconstruction. The functional results of the tympanoplasty must be considered only a partial success at this time; long-term evaluation as well as technologic improvements are needed.