title: Donor site reconstitution for ear reconstruction.
abstract: BACKGROUND
  Current techniques of autologous ear reconstruction involve the soft tissue coverage of a carved costal cartilage framework. However, assessment of the morbidity associated with this donor site has been little documented. This study describes a method to reconstruct the defect and analyses the outcomes with or without donor site reconstitution.
  
  
  METHODS
  The donor site was reconstituted by wrapping morcelised cartilage in a vicryl mesh. Twenty-one patients with reconstitution and nine without were recruited to the study. Scar quality and length, dimensions of donor defect and visible deformity were recorded according to a modified Vancouver scar scale. Patients were also assessed by the SF36 questionnaire, a well-validated health survey. In a subset of our study group, we assessed the fate of the donor site reconstitution by direct visualisation in situ and histological analysis.
  
  
  RESULTS
  Fifteen donor sites of patients without donor site reconstitution were compared to 23 reconstructed donor sites. In those without, all had a palpable defect with nearly half exhibiting visible chest deformity. In contrast, those that had rib reconstitution did not demonstrate significant chest wall deformity. Intraoperative examination demonstrated formation of a neo-rib, histologically proven to comprise hyaline cartilage admixed with fibrous tissue. Analysis of SF36 results showed a higher satisfaction in the reconstituted group, but in both groups, the donor site was of little overall morbidity.
  
  
  CONCLUSIONS
  Although there is little difference between the groups in terms of subjectively perceived benefit, rib reconstitution is objectively associated with better costal margin contour and less chest wall deformity.
authors.affiliation: Department of Plastic Surgery, Great Ormond St. Hospital for Children NHS Trust, Great Ormond St, London WC1N 3JH, UK. adelfattah@doctors.org.uk
authors.forename: Adel
authors.initials: A
authors.lastname: Fattah
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.forename: Neil W
authors.initials: NW
authors.lastname: Bulstrode
mesh_terms: D000293:Adolescent; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D002921:Cicatrix / Q000517:prevention & control; D004431:Ear, External / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D013506:Otologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012272:Ribs / Q000637:transplantation*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D016896:Treatment Outcome