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DOI: 10.1055/s-0029-1239445
The Learning Curve in Microtia Surgery
Publication History
Publication Date:
06 October 2009 (online)
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ABSTRACT
Reconstruction of the auricle is known to be complex. Our objective was to evaluate the improvement of the outcome of the lobulus-type microtia reconstruction. Patient satisfaction was also evaluated. There are no previous reports of the learning process in this field. Postoperative photographs of 51 microtia reconstructions were assessed and rated by a panel made up of six surgeons. The ratings were gathered to generate learning curves. Twenty-two patients assessed the outlook of their reconstructed ears, and the results were analyzed as a self-assessment group. The reliability of the rating by a panel was tested by intraclass correlations. There is a highly significant increasing trend in learning (p = 0.000001). This trend is not constantly upward, and the steady state was not reached during the study. In the self-assessment group, females were significantly more critical than males (p = 0.014). Intraclass correlation for six panel members was 0.90, and the rating was considered reliable. Thus, a long and gentle learning curve does exist in microtia reconstruction. To secure good quality and continuity, centralization of the operations and trainee arrangements are highly advisable. Outcomes of plastic surgery can reliably be rated by an evaluation panel.
KEYWORDS
Auricular reconstruction - learning curve - evaluation panel
REFERENCES
-
1 Marx H.
Die Missbildungen des Ohres . In: Denker A, Kahler O Handbuch der Hals-, Nasen- und Ohrenheilkunde mit einschluss der Grenzgebiete, Vol VI. Berlin, Germany; Springer-Verlag 1926: 131 - 2 Tanzer R C. Total reconstruction of the external ear. Plast Reconstr Surg Transplant Bull. 1959; 23 1-15
- 3 Brent B. Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg. 1992; 90 355-374 discussion 375-376
- 4 Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg. 2002; 29 257-271, vii
- 5 Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg. 1993; 92 187-201
- 6 Nagata S. Modification of the stages in total reconstruction of the auricle: part I. Grafting the three-dimensional costal cartilage framework for lobule-type microtia. Plast Reconstr Surg. 1994; 93 221-230 discussion 267-268
- 7 Castilla E E, Orioli I M. Prevalence rates of microtia in South America. Int J Epidemiol. 1986; 15 364-368
- 8 Harris J, Källén B, Robert E. The epidemiology of anotia and microtia. J Med Genet. 1996; 33 809-813
- 9 Ramsay C R, Grant A M, Wallace S A, Garthwaite P H, Monk A F, Russell I T. Statistical assessment of the learning curves of health technologies. Health Technol Assess. 2001; 5 1-79
- 10 Patel N, Shelton C. The surgical learning curve in aural atresia surgery. Laryngoscope. 2007; 117 67-73
- 11 Moffat D A, Hardy D G, Grey P L, Baguley D M. The operative learning curve and its effect on facial nerve outcome in vestibular schwannoma surgery. Am J Otol. 1996; 17 643-647
- 12 Kanzaki J, Inoue Y, Ogawa K. The learning curve in post-operative hearing results in vestibular schwannoma surgery. Auris Nasus Larynx. 2001; 28 209-213
- 13 Altgassen C, Michels W, Schneider A. Learning laparoscopic-assisted hysterectomy. Obstet Gynecol. 2004; 104 308-313
- 14 Gill J, Booth M I, Stratford J, Dehn T C. The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg. 2007; 11 487-492
- 15 Firmin F. Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg. 1998; 32 35-47
- 16 Shrout P E, Fleiss J L. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979; 86 420-428
- 17 Asher-McDade C, Brattström V, Dahl E et al.. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 4. Assessment of nasolabial appearance. Cleft Palate Craniofac J. 1992; 29 409-412
- 18 Tollefson T T. Advances in the treatment of microtia. Curr Opin Otolaryngol Head Neck Surg. 2006; 14 412-422
- 19 Romo III T, Reitzen S D. Aesthetic microtia reconstruction with Medpor. Facial Plast Surg. 2008; 24 120-128
- 20 Xu J W, Johnson T S, Motarjem P M, Peretti G M, Randolph M A, Yaremchuk M J. Tissue-engineered flexible ear-shaped cartilage. Plast Reconstr Surg. 2005; 115 1633-1641
- 21 Weidenbecher M, Tucker H M, Awadallah A, Dennis J E. Fabrication of a neotrachea using engineered cartilage. Laryngoscope. 2008; 118 593-598
- 22 Isogai N, Nakagawa Y, Suzuki K et al.. Cytokine-rich autologous serum system for cartilaginous tissue engineering. Ann Plast Surg. 2008; 60 703-709
Samuli SuutarlaM.D.
Laajasalonkaari 2B, 00840
Helsinki, Finland
Email: samuli.suutarla@kymshp.fi