Page 103 - Hospital Authority Convention 2017

Masterclasses

M6.3 Surgical Services at Hong Kong Children’s Hospital and 16:15 Convention Hall A
Plastic Surgery on Congenital Diseases

Plastic Surgery for the Ears: Common Otoplastic Procedures in Children
Tan T HOSPITAL AUTHORITY CONVENTION 2017
Department of Surgery, Prince of Wales Hospital, Hong Kong

Protruding ears and microtia (underdeveloped pinna) are frequently contributed to social derision, especially among school-
aged children. For these children, otoplasty can be performed resulting in improved self-image and confidence for both
patients and their families. In fact, otoplasty is one of the most commonly performed plastic surgical procedures in children.

Non-surgical correction of certain types of congenital ear deformities (such as prominent ears and cryptotia) may be adopted
if started early in the form of auricular splinting. Early splintage has been shown to be effective but requires a high level of
expertise and compliance.

There are various methods of surgeries for microtia which revolves around the same concept – harvesting rib cartilage for the
framework and putting it under the skin at the ear region. As the ears reach about 85% of adult size at four years of age and
the chest wall reaches a satisfactory size for rib cartilage harvest at an older age, most would advocate surgery for microtia
children between six and 10 years of age, to provide enough rib cartilage to make an adult ear size. This is at present the
most common method for surgical reconstruction of the ear.

Although harvesting rib cartilage for auricular reconstruction has been a well-established surgical treatment for many years,
there is risk associated including chest wall deformities, an additional scar, etc. Surgeons have been exploring methods to
provide improved cosmetic results with less discomfort without the chest wall scar. Dr Reinisch introduced his technique of
biocompatible implant Medpor to fabricate the auricular framework, eliminating the need to harvest rib cartilage.
There has been extensive research on bioprinting ear cartilage but no success in using them in humans as of date. Tuesday, 16 May

M6.4 Surgical Services at Hong Kong Children’s Hospital and 16:15 Convention Hall A
Plastic Surgery on Congenital Diseases

Plastic Surgery on Congenital Diseases: Management of Vascular Malformation – Surgery or Not
Lau EYK
Department of Surgery, Kwong Wah Hospital, Hong Kong
Vascular malformations (VM) form part of the vascular anomaly spectrum that describes congenital morphological errors
of vascular development. Despite being “congenital” (i.e. present at birth), they may not become apparent until later stages
in life. While some malformations may be attributed to genetic inheritance, most of them do not have a specific cause. The
elucidation of etiology/pathogenesis has remained difficult due to imprecise nomenclatures in the past.

VMs may involve veins, arteries, lymphatics, or in combination. High-flow VMs include an arterial component, while low-
flow VMs do not. Although benign in nature, VMs may involve any anatomical structure. Depending on their components and
anatomical location, they may cause significant morbidities to patients including skin changes, pain, bleeding, ulceration,
recurrent infections, and even heart failure.

Patients with VMs are often referred to plastic surgeons since the integument is most commonly affected. However, as VMs
often have a rather diffuse anatomical involvement, surgery may not represent the ideal solution due to excessive surgical
morbidity; therefore, referral to a multi-disciplinary team is warranted in most cases. In this presentation, input from different
medical specialties and the role of plastic surgeons in the management of VMs are discussed.

101