The burned ear; possibilities and challenges in framework reconstruction and coverage.
Ear reconstruction remains a challenging procedure, especially in burn victims. The ear is particularly vulnerable to thermal injury because of its location and the thin integument. The thermal injury could subsequently include skin and the deeper located auricular cartilage framework. This type of injury could have long lasting mutilating effect not only because the ear's morphology is mainly related to this framework but also because it will not recover or regenerate once injured. Grafts of costal cartilage or synthetic materials might replace missing cartilage. However, the poor quality of the adjacent skin and subcutaneous tissues makes the reconstruction of a burned ear an even more daunting procedure than congenital or many oncologic indications. As such, regeneration of the skin will be the next step in reconstruction of the burned ear. There is still much development and research to be done, but encouraging results have been shown in tissue engineering of skin and cartilage. Furthermore, 3D (bio)printing of cartilage to facilitate reproduction of the ear's complex shape certainly has potential and might find an interesting role in ear reconstruction. In this review, different clinical challenges and options for ear reconstruction in burn patients are described. Subsequently, although still far from large scale clinical application, state of the art developments in the field of tissue engineering and 3D (bio)printing are also discussed.
Department of Plastic, Reconstructive and Hand Surgery, VUMC Amsterdam, The Netherlands; Burns Centre and Dept of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; MOVE Research Institute, VUMC, The Netherlands.
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Department of Plastic, Reconstructive and Hand Surgery, VUMC Amsterdam, The Netherlands.
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Doerga
Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, UMC Utrecht, The Netherlands; Department of Plastic Surgery Meander Medical Center, Amersfoort, The Netherlands.
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Breugem
Department of Plastic, Reconstructive and Hand Surgery, VUMC Amsterdam, The Netherlands; Burns Centre and Dept of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; MOVE Research Institute, VUMC, The Netherlands. Electronic address: pvanzuijlen@rkz.nl.
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van Zuijlen
D002056:Burns / Q000601:surgery*; D066186:Costal Cartilage / Q000637:transplantation; D006259:Craniocerebral Trauma / Q000601:surgery*; D004425:Ear Cartilage / Q000293:injuries / Q000601:surgery; D004426:Ear Deformities, Acquired / Q000601:surgery*; D004431:Ear, External / Q000293:injuries / Q000601:surgery*; D006801:Humans; D066330:Printing, Three-Dimensional; D019651:Plastic Surgery Procedures / Q000379:methods*; D017768:Skin, Artificial; D013524:Surgical Flaps; D023822:Tissue Engineering
Auricular; Burns; Cartilage framework; Reconstruction; Tissue engineering