The Regenerated Tissue at the Donor Site After Costal Cartilage Harvest for Auricular Reconstruction

Ribs with Anterior Protrusion (Winged Ribs) Treated Using Percutaneous Chondroplasty

Background

Thoracic features play a significant role in determining various plastic surgery techniques. Particularly, the thorax has potential for excessive anterior projection, commonly referred to as winged ribs. This study aimed to describe a treatment method for addressing winged ribs for aesthetic purposes using percutaneous chondral management.

Methods

Thirty-two female patients underwent FrontXribs from February to March 2023. Two angular measurements were obtained: (1) the angle formed by lines intersecting tangentially to the shoulder and the lower gluteal border; and (2) the angle formed by a line tangential to the greatest anterior projection, intersected by a vertical line on the standing axis. Length measurements were obtained using a tape measure at the position of the greatest thoracic projection. Pulmonary function studies were conducted. All variables were measured before surgery and 6 months postoperatively.

Results

On average, patients were 25 years old. The average operative time was 51.1 minutes, and all patients underwent general anesthesia. The average increase for angular measurement 1 was 26.1 degrees, whereas that for angular measurement 2 was 3.43 degrees. The average decrease in anterior chest length during the postoperative period was 9.66 cm (P < 0.001). Spirometric tests showed no significant changes 6 months postoperatively.

Conclusions

The FrontXribs technique for treating winged ribs effectively reduces anterior costal protrusion, as evidenced by the angular variation of projections and the reduction in thoracic length at this level. No adverse effects on respiratory function were observed 6 months postoperatively.

Minimally Invasive Costal Cartilage Harvesting Incision for Chest Deformity in Microtia Reconstruction

BACKGROUND

Chest deformity is a potential complication associated with auricular reconstruction using autologous costal cartilage. The impact of the incision size employed for costal cartilage harvesting on chest deformities remains unclear. This study aimed to investigate the correlation between the incision size used for harvesting costal cartilage and the occurrence of chest deformities.

METHODS

We retrospectively analyzed patients who underwent ear reconstruction using autologous costal cartilage between June 2021 and September 2022. The patients were categorized into two groups based on the size of the costal cartilage incision: large and small. Chest computed tomography (CT) was performed 18-24 months postoperatively, followed by three-dimensional color map quantification to assess the degree of asymmetry of the chest surface. Subsequently, quantitative data analysis was performed to compare the extent of chest asymmetry between the large- and small-incision groups. The Visual Analog Scale (VAS) was used to assess patient satisfaction with chest morphology.

RESULTS

This study included 62 patients, with an equal distribution of 31 in each group. The mean asymmetry value of the small and large incision groups was -3.15 ± 1.88 and -5.27 ± 3.63, respectively. Moreover, the mean VAS score for the small and large incision groups was 7.48 ± 0.72 and 5.09 ± 0.94, respectively. Statistically significant differences were observed between the two groups.

CONCLUSIONS

Small incision costal cartilage harvesting can effectively alleviate the severity of chest deformities and significantly enhance patient satisfaction.

LEVEL OF EVIDENCE IV

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Comprehensive analysis of donor-site chest deformities after autologous costal cartilage microtia reconstruction: A systematic review

BACKGROUND

Autologous costal cartilage has gained widespread acceptance as an important material for ear reconstruction in patients with microtia. Despite its recognition as being "worth the trade-off," attention should be directed toward donor-site deformities. This systematic review focused on existing English literature related to microtia reconstruction and aimed to reveal the incidence of chest wall deformities and assess the effectiveness of the various proposed surgical techniques aimed at reducing donor-site morbidities.

METHODS

A comprehensive search was conducted on Pubmed and OVID using the keywords "microtia," and "chest deformity" or "rib harvest." Articles were screened based on predefined inclusion and exclusion criteria. Data acquisition encompassed patient demographics, employed surgical techniques, methods for evaluating chest deformity, and incidence of associated complications.

RESULTS

Among the 362 identified articles, 21 met the inclusion criteria. A total of 2600 cases involving 2433 patients with microtia were analyzed in this review. Perichondrium preservation during cartilage harvesting led to a significant reduction in chest deformities. However, the wide incidence range (0% to 50%) and the lack of specific assessment methods suggested potential underestimation. Computed tomography revealed reduced chest wall growth in the transverse and sagittal directions, resulting in decreased thoracic area. Innovative surgical techniques have shown promising results in reducing chest deformities.

CONCLUSIONS

Although a quantitative analysis was not feasible, objective evidence of deformities was established through computed tomography scans. This analysis highlighted the need for dedicated studies with larger sample sizes to further advance our understanding of chest wall deformities in microtia reconstruction.

Update on Total Auricular Construction

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management.

SUMMARY

Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors' focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.

Free dermofat grafting for chest deformity in microtia reconstruction

OBJECTIVE

Chest deformity is one of the complications that occurs after costal cartilage harvesting for auricle reconstruction. In this study, we presented a novel method of free dermofat grafting to repair cartilage defect and aimed to evaluate its effect in ameliorating chest deformity.

METHODS

Seventy-six pediatric patients were included in the study, comprising free dermofat grafting group (n = 38) and control group (n = 38). After harvesting costal cartilage, empty perichondrial space of right seventh costal cartilage was filled with free dermofat grafts in free dermofat grafting group. Thoracic computed tomography (CT) was performed three months after surgery and 3D colormap quantification was performed to quantify chest surface asymmetry. The quantified data were further analyzed to compare chest asymmetry level in free dermofat grafting and control groups.

RESULTS

In the free dermofat grafting group, the mean of asymmetry level was 2.2 mm. While in the control group, the mean of asymmetry was 5.7 mm. After a comparison between the two groups, the level of asymmetry showed a significant difference (p < 0.01).

CONCLUSION

Free dermofat grafting method is easy to perform and a feasible option for ameliorating chest deformity in microtia reconstruction.

The characterization, cytotoxicity, macrophage response and tissue regeneration of decellularized cartilage in costal cartilage defects

After harvesting multiple costal cartilages, the local defect disrupts the integrity of the chest wall and may lead to obvious thoracic complications, such as local depression and asymmetry of the bilateral thoracic height. Decellularized materials have been used for tissue reconstruction in clinical surgeries. To apply xenogenic decellularized cartilage in costal cartilage defects, porcine-derived auricular and costal cartilage was tested for characterization, cytotoxicity, macrophage response, and tissue regeneration. Most of the DNA and α-Gal were effectively removed, and the collagen was well preserved after the decellularization process. The glycosaminoglycan (GAG) content decreased significantly compared to that in untreated cartilage. The decellularized auricular cartilage had a larger pore size, more pores, and a higher degradation rate than the decellularized costal cartilage. No apparent nuclei or structural damage was observed in the extracellular matrix. The decellularized auricular cartilage had a higher cell proliferation rate and more prominent immunomodulatory effect than the other groups. Two types of decellularized cartilage, particularly decellularized auricular cartilage, promoted the tissue regeneration in the cartilage defect area, combined with noticeable cartilage morphology and increased chondrogenic gene expression. In our research, the functional components and structure of the extracellular matrix were well preserved after the decellularization process. The decellularized cartilage had better biocompatibility and suitable microenvironment for tissue regeneration in the defect area, suggesting its potential application in cartilage repair during the surgery. STATEMENT OF SIGNIFICANCE: Autologous costal cartilage has been widely used in various surgeries, while the cartilage defects after the harvesting of multiple costal cartilages may cause localized chest wall deformities. Decellularized cartilage is an ideal material that could be produced in the factory and applied in surgeries. In this study, both decellularized costal cartilage and auricular cartilage preserved original structure, functional biocompatibility, immunosuppressive effects, and promoted tissue regeneration in the cartilage defect area.