Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: A systematic review

E M Ronde; M Esposito; Y Lin; F S van Etten-Jamaludin; N W Bulstrode; C C Breugem

doi:10.1016/j.bjps.2021.08.004

Long-term aesthetics, patient-reported outcomes, and auricular sensitivity after microtia reconstruction: A systematic review

J Plast Reconstr Aesthet Surg. 2021 Dec;74(12):3213-3234. doi: 10.1016/j.bjps.2021.08.004. Epub 2021 Aug 19.

Authors

E M Ronde¹, M Esposito², Y Lin³, F S van Etten-Jamaludin⁴, N W Bulstrode⁵, C C Breugem⁶

Affiliations

¹ Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: e.m.ronde@amsterdamumc.nl.
² Department of Plastic and Reconstructive Surgery, La Sapienza, University of Rome, Rome, Italy; Department of Plastic and Maxillofacial Surgery, Cleft and Craniofacial Malformation Center, Bambino Gesù Children's Hospital, Rome, Italy.
³ Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Plastic Surgery Hospital, Peking Union Medical College, Beijing, China.
⁴ Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands.
⁵ Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
⁶ Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

PMID: 34489212
DOI: 10.1016/j.bjps.2021.08.004

Abstract

Background: Auricular reconstruction for microtia is most frequently performed using autologous costal cartilage (ACC) or porous polyethylene (PPE) implants. Short-term results are generally promising, but long-term results remain unclear. Long-term outcomes were explored in this systematic review, and minimal reporting criteria were suggested for future original data studies.

Methods: A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included if postsurgical follow-up was at least 1 year. Outcome reporting was split into separate publications, and results on complications were reported previously. This publication focused on long-term aesthetic, patient-reported, and sensitivity outcomes.

Results: Forty-one publications reported on these outcomes. Both materials led to aesthetically pleasing results and high rates of patient satisfaction. ACC frameworks grew similarly to contralateral ears, and the anterior surface of auricles regained sensitivity. Furthermore, postoperative health-related quality of life (HRQoL) outcomes were generally good. Data synthesis was limited due to considerable variability between studies and poor study quality. No conclusions could be drawn on the superiority of either method due to the lack of comparative analyses.

Conclusion: Future studies should minimally report (1) surgical efficacy measured using the tool provided in the UK Care Standards for the Management of Patients with Microtia and Atresia; (2) complications including framework extrusion or exposure, graft loss, framework resorption, wire exposure and scalp/auricular scar complications and (3) HRQoL before and after treatment using the EAR-Q patient-reported outcome measure (PROM).

Keywords: Auricular reconstruction; Autologous costal cartilage; Long-term outcomes; Medpor; Microtia; Porous polyethylene.

Publication types

Systematic Review

MeSH terms

Congenital Microtia / surgery*
Costal Cartilage / transplantation
Esthetics*
Humans
Patient Reported Outcome Measures*
Patient Satisfaction
Plastic Surgery Procedures / methods*
Postoperative Complications
Prostheses and Implants