LAUSR

Dear Editor, Congenital microtia is a common congenital disease in Asia [1]. At present, the main method of plastic surgeons to treat congenital microtia is ear reconstruction [2]. Although ear scaffolds made by tissue engineering technology are expected to be used in ear reconstruction surgeries [3], ear scaffolds carved with costal cartilage are still widely used in ear reconstruction surgeries [4]. Recently, we read the published study by Rui Wan, Xingyuan Pang and Jun Ren about using a four-layer sculpted rib cartilage framework to increase the transverse height of the reconstructive ear in one operative stage for microtia patients [5], carefully. In this article, the ear reconstruction surgery used by the authors is divided into three stages. In the first stage, the authors used a 50-ml nephroid dilator to dilate the skin behind the remnant ear. In the second stage, the authors used the costal cartilage to make a four-layer ear stent, and used the ear stent for auricle reconstruction. In the third stage, the authors repaired the reconstructed ear, including the reconstruction of the tragus, deepening of the auricle cavity, and so on. At present, the surgical method of ear reconstruction introduced by the authors has been widely used in the treatment of congenital microtia. In the article, the authors used a four-layer ear scaffold to make the cranioauricular angle of the reconstructed ear close to or equal to the cranioauricular angle of the normal ear. However, the authors neglected the fact that too high a four-layer ear scaffold may cause blood circulation disturbance to the flap used to cover the ear scaffold. It is known that the failure of blood circulation of the flap will lead to ischemia and necrosis of the flap [6], leading to the exposure of the ear stent and the failure of ear reconstruction. Although the authors used the technique of skin grafting behind the ear to reduce tension and ensure the blood supply of the flap used to cover the ear stent as much as possible, they ignored the importance of the postoperative incision dressing. If the dressing of the incision is more pressure on the operation area, the flap covering the ear stent will also be compressed, resulting in the ischemia and necrosis of the flap. In the ear reconstruction surgery, we invented the crescent dressing method, which avoided the pressure of the flap covering the ear stent when dressing, so as to ensure the flap would not be ischemic and necrotic due to the pressure of dressing. The method of crescent dressing was to use sterilized medical cotton to make a ‘‘C’’ shape, shaped like a crescent. The first step, we placed the ‘‘C’’ cotton behind the ear, covered the incision with oil yarn, and placed a gauze dressing over the ‘‘C’’ cotton (Fig. 1). This avoided pressure from gauze dressings on the flap covering the ear stent. The second step, we used sterile bandage to fix gauze dressing, the winding force of sterile & Bo Pan [email protected]