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Current Management of the Patient with Microtia: A National Plastic Surgery Survey
Daniel D. Im1, Boris Paskhover1, Reza Jarrahy, M.D.2, David A. Staffenberg, M.D., D.Sc (Hon)3
1Albert Einstein College of Medicine, Bronx, NY, USA, 2UCLA Division of Plastic and Reconstructive Surgery, Los Angeles, CA, USA., 3NYU Langone Medical Center, Department of Plastic & Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York, NY, USA
Microtia refers to a spectrum of congenital deformities of the external ear ranging from a slightly smaller ear to absence of the external ear. Microtia reconstruction remains one of the most challenging procedures encountered by the reconstructive surgeon. The three main options for reconstruction of microtia are: (1) Autogenous cartilage reconstruction, (2) Alloplastic (MedPor) reconstruction, and (3) Prosthetic reconstruction. The use of autologous rib cartilage, originally described by Gillies in 1920, is traditionally considered the gold standard for microtia repair. A national report on the current management of microtia has never been presented before. The purpose of this project was to survey members of the American Society of Plastic Surgeons (ASPS) to identify their preferences and practices and report their opinion regarding issues related to microtia reconstruction in order to contribute a substantial report of the current state of microtia reconstruction.
An anonymous web-based survey consisting of 20 questions was distributed to the members of the ASPS. Questions focused on practices and results surrounding the surgical management of microtia. The study was designed as a descriptive correlation survey.
Preliminary results show that 38 percent of respondents perform microtia reconstruction; 47 percent of these completed a craniofacial fellowship. 91 percent learned the autogenous cartilage based reconstruction, while only 17 percent and 13 percent were exposed to alloplastic (MedPor) and osseo-integrated prosthetic reconstruction, respectively. 89 percent of respondents currently prefer to use autogenous cartilage in a staged reconstruction, using approximately 3 operative stages. 47 percent report a steep learning curve, while 41 percent report a lack of consistency in results. Respondents estimate a 15 percent complication rate. In the pediatric patient population, 49 percent prefer performing the surgery between 7-10 years of age, while 40 percent prefer 4-6 years of age. 62 percent ranked the creation of an aesthetically pleasing ear for the patient as the most important outcome of reconstruction, while 23 percent ranked the potential to minimize psychosocial morbidity as most important. Respondents report that operating on older patients yields a better aesthetic outcome but put the patient at risk for greater psychosocial morbidity stemming from the delay in treatment. Fifty-nine percent believe that in 15 years, tissue engineering will represent the gold standard of microtia reconstruction.
Staged microtia repair using autogenous cartilage remains the heavily favored method of microtia reconstruction amongst pediatric plastic surgeons. While there is great hope for the future with tissue engineering, the presented results highlight that currently, there is a general lack of evolution of the surgical approach to microtia compared to originially described techniques. Moreover, there is a deficiency in training relative to newer surgical techniques, such as alloplastic and osseointegrated options. Considering microtia surgeons’ preferences for timing of surgery in the pediatric population in contrast to the expansive literature that describes significant psychosocial morbidity in older children with untreated craniofacial disorders, there is a continuing need to elucidate the best timing for microtia repair.
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