الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
There are many Indications for auricular reconstruction including post-traumatic, post-burn auricular loss and most importantly microtia.
Partial auricular reconstruction has started since the ancient times. Many flaps have been proposed but due to lack of good auricular support, the results weren’t satisfactory. That is when authors started thinking of total auricular reconstruction. This has gone through many phases until reached the final shape known nowadays.
Many substitutes for costochondral cartilage have been proposed as alloplastic implants and auricular prothesis. Both are valid methods for auricular reconstruction, and have their advantages, disadvantages and indications. But till today It is agreed that whenever the circumstances are suitable, autogenous rib cartilage grafts are advised.
The fact of limited amount of rib cartilage available and limited skin coverage makes it important to wisely use the available resources. That is why many training modules and materials have been proposed.
Vegetables as carrots and potatoes, cadavers, dental silicones, plastic erasers and bovine cartilage have been used as training methods mimicking the real cartilage to improve the surgical skill of a plastic surgeon, decrease the rate of patient dissatisfaction and decrease the operative time consumed during the carving process.
In this study, two materials were used for training on auricular carving: ”Synthetic foam that is used for thermal insulation” and ”Bovine cartilage”.
The study involved 40 carving trials, 20 of them were in bovine cartilage and the other 20 were in synthetic foam. The study was conducted in a skill-lab at Minia& Kasr Al-Ainy University Hospitals in the period from November 2018 to May 2019.
Carving trials were done sequentially starting with the synthetic foam material. All carving trials were done using Firmin’s technique. A device inspired by Firmin’s trainer was executed and used to compare the carved framework to the original human auricle that was used as a template for the carved auricle in the first place.
Assessment of the carved frameworks were done subjectively by 3 experienced Plastic Surgeons and 3 non-experienced personnel and they rated each framework using 5-point Likert scale.
Carving trials were divided into 8 groups. group 1-4 included foam carvings. group 5-8 included bovine cartilage carvings. Each group consisted of 5 carvings. Comparison between the outcome of each group were done. Statistical analysis showed that there was a significant difference between group 4 and group 1 indicating the time factor. group 4 was much better than group 5 as group 5 included first five bovine cartilage carvings in which much more experience and more tools were needed more than foam carvings so the results went down for a while then started to rise again. The last group; group 8 showed the best results among the 8 groups.
A workshop was conducted on auricular carving training using the Synthetic Foam material. 25 participants were involved and stated that synthetic foam is easy for beginners and helps learning basic structures to be carved but doesn’t resemble real cartilage and is not enough as the only preoperative training.
Three case studies were operated after the training period was over. One of them had cartilage exposure due to infection and needed another surgical session. All three frameworks were satisfactory and were carved using Firmin’s technique. All three patients were moderately satisfied with their reconstructed auricles.
Carving training decreases consumed time during the operation, increases the skills of the surgeon. Synthetic foam is a convenient material for starting to learn the basic steps of auricular carving.