Comprehensive perioperative nursing with personalized psychological counseling: Alleviating anxiety/depression following total auricular reconstruction

Abstract

BACKGROUND

Congenital microtia is a common craniofacial malformation in children that not only affects facial appearance but also has substantial psychological effects. The emotional consequences of auricle deformities are increasingly recognized in affected children.

AIM

To optimize perioperative nursing for patients undergoing total auricular reconstruction by examining the impact of comprehensive perioperative nursing combined with personalized psychological counseling on anxiety and depression.

METHODS

Eighty patients who underwent total auricular reconstruction from January 2023 to December 2024 were enrolled. The control group (n = 40) received standard perioperative care, while the observation group (n = 40) received the same care plus personalized psychological counseling. Patients were accessed preoperatively and 1 month postoperatively using the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Rosenberg Self-Esteem Scale (SES), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Nursing satisfaction was evaluated, and postoperative complications were monitored.

RESULTS

Baseline SAS, SDS, SES, and WHOQOL-BREF scores were compared between groups (P > 0.05). One month postoperation, the observation group demonstrated greater psychological improvement, reflected by lower mean SAS (36.87 ± 3.89 vs 45.21 ± 4.35; t = 9.253, P < 0.05) and SDS (34.21 ± 3.67 vs 43.56 ± 4.12; t = 10.587, P < 0.05) scores. They also showed higher postoperative SES and WHOQOL-BREF results. Nursing satisfaction was higher (97.50% vs 82.50%) and postoperative complications were fewer (5% vs 20%; P < 0.05) in the observation group.

CONCLUSION

Personalized psychological counseling improves patients’ mental health before and after auricular reconstruction, enhances nursing satisfaction, and reduces complications. These findings underscore its clinical significance and support its broader application in perioperative complications.

Key Words: Personalized psychological counseling; Total auricular reconstruction; Comprehensive perioperative nursing; Anxiety/depression; Complications

Core Tip: Congenital microtia is a common craniofacial deformity in children, and auricular reconstruction remains the preferred corrective approach. Because the ear’s anatomy is complex and the reconstructed auricle is fragile postoperatively, children’s mental health becomes crucial, directly influencing cooperation and wound healing. Psychological counseling has been shown to improve emotional well-being. This study aims to investigate the impact of comprehensive perioperative nursing combined with personalized psychological counseling on anxiety and depression in children undergoing surgery.

INTRODUCTION

Congenital microtia is a common craniofacial deformity in children that affects facial aesthetics and can have lasting psychological effects. As affected children mature, greater self-awareness heightens the emotional impact of auricular deformities. Toddlers may experience distress in response to others’ gaze, while primary school-age children often face ridicule and marginalization that causes inferiority complex and social withdrawal. Teenagers pay more attention to self-image, which may contribute to depressive symptoms, decreased academic motivation, impaired peer interaction, and persistent emotional distress that hinders healthy personality development[1].

For such children, auricular reconstruction remains the preferred corrective intervention, aiming to create an ear with natural appearance and texture. Successful restoration of auricular contour is crucial for reducing psychological burden and improving overall well-being of affected children[2]. However, reconstruction is technically demanding due to the ear’s complex anatomy, and the postoperative framework is fragile. Children undergoing this procedure commonly experience significant psychological pressure: Preoperative anxiety related to expected pain and uncertain outcomes, heightened insecurity in unfamiliar clinical environments, and postoperative concern about cosmetic result that may worsen depressive symptoms if expectations are unmet.

Standard perioperative care - such as health education, body position, and complication prevention[3] - often overlooks these psychological needs. Age-specific differences further complicate care, as young children may express fear through crying or poor eating, whereas older children may conceal emotional distress due to self-esteem, making emotional issues easy to miss. Evidence indicates that psychological counseling can improve emotional outcomes in children[4].

Personalized counseling is particularly effective because it incorporates continuous assessment and tailored strategies based on developmental stage and individual characteristics. However, few studies have examined comprehensive, personalized perioperative psychological interventions for children with auricular deformities; existing research focuses on isolated perioperative stages rather than integrating preoperative evaluation, intraoperative support, and postoperative rehabilitation. Based on this evidence, this study aims to develop an integrated nursing model that incorporates personalized psychological counseling throughout the perioperative process for pediatric patients with ear deformities, especially targeting anxiety and depression. By comparing this model with standard care and assessing psychological status, complications, and satisfaction, the study seeks to demonstrate its effectiveness in improving both surgical and psychological outcomes to inform evidence-based perioperative care for total auricular reconstruction (TAR).

MATERIALS AND METHODS

Research participants

From January 2023 to December 2024, 80 patients who received TAR at the Guangdong Second People’s Hospital were recruited and allocated to either the control or observation group (40 cases/group). Qualification criteria included: (1) Candidates for TAR[1]; (2) Aged 6-30 years; and (3) Normal cognitive function and communication ability. Exclusion criteria included: (1) Severe mental disorders; (2) Dysfunction of major organs (heart, liver, or kidneys); (3) Hearing defects; (4) Other congenital malformations; and (5) Poor compliance.

Nursing methods (control group)

The controlled group received standard perioperative nursing. Preoperatively, nursing care included completing required examinations, preparing the skin according to aseptic protocols, and providing basic preoperative education. Dietary and activity guidance and standard health education were also offered. Intraoperatively, nursing care focused on assisting the surgical team and monitoring hemodynamic stability. Postoperative care prioritized wound management - maintaining cleanliness and dryness and assessing healing - while continuing dietary and activity guidance as well as standard health education.

Nursing methods (observation group)

The observation group received standard perioperative care supplemented with personalized psychological counseling, implemented through the following measures.

Comprehensive nursing interventions

Admission assessment: Information on prior surgical interventions and the presence of systemic diseases or malformations was collected. Physical fitness, rib cartilage development, and local auricular condition were evaluated. Eligibility required patients to be over 6 years old, taller than 120 cm, and with a chest circumference exceeding 55 cm.

Preoperative nursing: (1) Routine examinations were completed, and blood preparations were arranged as needed; (2) Preoperative guidance: Patients were instructed on perioperative precautions, with emphasis on nutrition, regular schedule, and adequate sleep to enhance resistance, promote healing, and prevent infectious skin necrosis. Patients bathed and changed clothes the day before surgery; male patients had their heads shaved, while female patients had hair within 10 cm of the affected ear removed, with chest and abdominal skin prepared accordingly; (3) Posture training: After unilateral surgery, patients were instructed to lie on the unaffected side or supine. For bilateral procedures, they were required to remain supine with head immobilization; (4) Imaging records: Preoperative anterior-posterior and lateral photographs of the ear(s) were taken for postoperative comparison; and (5) Gastrointestinal preparation: To prevent aspiration during anesthesia or surgery, a preoperative fasting period of 12 hours and water deprivation for 6 hours were required.

Intraoperative nursing: (1) Posture management: Patients were positioned comfortably and safely while meeting surgical requirements; and (2) Safety management: Pressure sore prevention measures were implemented, electrosurgical equipment was used safely and appropriately, and adequate warmth was maintained during the procedure.

Postoperative care: (1) Vital signs and incision monitoring: The surgical team continuously monitored vital signs, blood oxygen saturation, and incisional hemorrhage to prevent hypovolemic shock; (2) Surgical site care and infection prevention: The surgical area was kept clean and dry, strictly following aseptic procedures, and dressings were changed promptly to minimize infection risk. Skin temperature and color at surgical site were closely monitored, and abnormalities were reported to the physician immediately; (3) Positioning management: After anesthesia, patients were required to lie flat without a pillow for 6 hours. Once blood pressure stabilized, they were repositioned to a semi-reclining position, with the head turned toward the healthy side to avoid pressure on the reconstructed ear. Patients were strictly confined to bed for the first 24 hours and then gradually encouraged to resume out-of-bed activities; (4) Medical environment management: The ward was kept clean and ventilated twice daily, with appropriate temperature and humidity. Smoking was strictly prohibited; (5) Temperature monitoring: A body temperature around 37.5 °C within 3 days postoperatively was considered normal. Patients were encouraged to drink warm water. If the body temperature exceeded 38 °C and with discomfort, the physician was notified promptly for evaluation and management; (6) Negative pressure drainage management: Drainage was used to remove accumulated blood and fluid and to ensure close adherence of the skin flap to the stent. A negative pressure of 20-30 mmHg was maintained, and drainage volume, color, and texture were recorded over a 24-hour period. Catheters were generally retained for 5 days, and removed when daily output dropped below 10 mL; and (7) Donor site care (costal cartilage): Cartilage was harvested from the 6^th-8^th costal region on the healthy side. Monitoring included assessment for bleeding and swelling at the donor site and evaluation of respiratory status. The chest was immobilized using wide adhesive tape or multiple elastic bands. Respiratory care encompassed deep-breathing and effective coughing techniques. Aerosol inhalation therapy was administered for thick sputum, and lung infections were prevented via regular repositioning and back percussion.

Potential complication observation and nursing: (1) Infection: Graft infection is the most severe complication. Once it occurs, the transplanted cartilage may liquefy, necrotize, or discharge. In such cases, the necrotic cartilage was removed to control infection; (2) Pleural injury: Insufficient dissection during cartilage harvesting may tear the pleura. When this occurred, repair was performed using a tapered needle, and closed thoracic drainage was instituted if necessary; (3) Graft (cartilage scaffold) exposure: Minor exposure could heal via epithelial migration, whereas larger extensive exposure required reoperation with a transferred skin flap; (4) Suture exposure: Exposure along the helical rim was resolved by removing the exposed sutures. Exposure of the fixator wire was similarly addressed by removal without typically compromising graft stability; (5) Skin graft failure: This was often caused by subcutaneous hematoma or infection. Minor necrosis healed gradually with dressing changes and epithelial migration; larger areas required secondary regrafting; and (6) Expander exposure: This resulted from excessive flap tension, overly rapid expansion, or improper expander placement. Once exposure occurred, the expander was removed and reinserted during a later procedure.

Discharge education: Patients received guidance regarding diet and the protection of the reconstructed ear(s).

Psychological counseling measures

Forming a nursing group: A nursing group was formed according to departmental needs and staffing. The group was led by a senior head nurse with guidance from a psychologist and group member responsibilities were clearly defined.

Profiling: The department organized annual health education lectures and voluntary expert consultations for patients with congenital microtia. Follow-up records were established for age-eligible patients and those newly expressing interest in surgical correction. Detailed patient information - age, height, weight, chest circumference, ear condition (unilateral/bilateral), contact information, and scheduled surgery date - was recorded. Each patient was paired with a designated nurse to ensure precise, personalized follow-up.

Health education: Before hospitalization, the designated follow-up nurse provided individualized education and maintained contact via phone or WeChat: (1) Because many patients experience inferiority complex, isolation, and anxiety, nurses provided detailed explanations to patients and family members to alleviate psychological pressure and stabilize emotions. Expectations for surgery were often high, so counseling approaches were tailored for patients’ psychological characteristics to address preoperative concerns and encourage cooperation. With parental consent, photographs of successful ear reconstruction cases were shown to enhance visual understanding and strengthen confidence in the treatment outcomes; (2) Postural training: Families were instructed to begin position training 1 month before surgery so that the child could adopt the correct postoperative posture. After unilateral reconstruction, patients were placed in a contralateral or supine position; following bilateral surgery, a strict supine position with head immobilization was required; (3) Health status evaluation: Nurses assessed physical condition, costal cartilage development, local earlobe status, and any infection, ulceration, or scarring to determine surgical suitability. For families traveling from other regions, parents were advised to schedule surgery when the child was in optimal physical condition. During travel, attention to clothing changes was emphasized to prevent colds, especially for children from northern regions who may need to adapt to temperature and air-conditioning changes; (4) Psychological evaluation: Psychological status was assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)[5,6]; and (5) Parents were instructed to frequently clean the child’s surgical-area skin, remove earwax, and complete preoperative preparation. Hair within 5-10 cm of the operative area (excluding eyebrows and eyelashes) was shaved the day before surgery, followed by washing the head with 0.1% benzalkonium bromide solution. The chest and armpits were cleaned, and hair was shaved for patients with significant chest or armpit hair.

Postoperative care: Nurses provided one-to-one psychological support during the perioperative period. Within 24 hours post-operation, patients were encouraged to ambulate. A quantitative schedule for daily out-of-bed activities was formulated to facilitate postoperative recovery. Family members were encouraged to accompany patients through activities such as sand-tray games and storytelling to promote rehabilitation. Birthday celebrations - including songs and sharing of cake - were held for hospitalized children. During follow-up after discharge, staff monitored recovery and emotional adjustment, conducted health check-ups, and encouraged participation in social activities.

Discharge health education and follow-up: Educational materials were provided in both paper and electronic formats: (1) Because the reconstructed ear is less sensitive and the elasticity of the cartilage scaffold differs greatly from that of the normal auricle, medical staff emphasized the need to strengthen self-protection awareness at discharge; (2) A disposable small ear protection cover developed by the department was used to protect the reconstructed ear. This cover maintains shape, provides durable protection without causing skin pressure, and its soft, transparent airbag material increases comfort and skin-friendliness while allowing clear observation of the surgical ear; (3) Patients were instructed to eat light, nutritious, and high protein food, avoid spicy or irritating foods, and avoid seafood, beef, and mutton for 3 months postoperation; (4) Scar prevention: Nurses advised patients and family numbers that scabs should fall off naturally and not be removed forcibly. Through WeChat video consultation, patients were instructed to start applying anti-scar ointment and patches 2 weeks after surgery. Early dot matrix laser treatment at the skin graft-junction was recommended to reduce scarring. One month after the second-stage operation, depigmenting laser could be used on grafted skin to better match normal skin tone; and (5) The placement of the expander was designed according to the reconstructed ear’s location. If the area of the skin behind the ear was limited, skin-flap expansion could be selected, with partial scalp application in the second stage. During expansion, hair loss would be treated with laser. Fine hair on the auricle could later be removed with laser hair removal at a later date. Generally, after five sessions of laser hair removal, good results can be achieved. Personalized care and follow-up reminded patients to attend regular treatments, improving overall outcomes.

Endpoints

Psychological state: Anxiety was assessed using Zung’s SAS[5] 1 day before and 1 month after surgery. This 20-item scale uses a 4-point response format; total score < 50 indicates no anxiety, 50-59 indicates mild anxiety, 60-69 indicates moderate anxiety, and ≥ 70 indicates severe anxiety.

Depressive symptoms were evaluated using Zung’s SDS[6], a 20-item instrument with a 4-level rating system. Total score < 53 indicates no depression, 53-62 indicates mild depression, 63-72 indicates moderate depression, and > 72 indicates severe depression.

Self-esteem measurement: Self-esteem was measured using the 10-item Self-Esteem Scale (SES)[7], with a total score of 10-40. Assessments were conducted one day before and 1 month after surgery, with higher scores reflecting greater self-esteem.

Quality of life: Quality of life was evaluated with the WHO Quality of Life-BREF[8] questionnaire 1 day before and 1 month after surgery. The 26-item tool includes two stand-alone items and four domains - physiological, psychological, social, and environmental. Items are scored 1-5, with several reverse-scored. Higher scores indicate better domain-specific functioning and superior quality of life. Domain totals are calculated by multiplying the mean item score by 4.

Nursing satisfaction: One month after surgery, nursing satisfaction was assessed with a hospital-designed questionnaire evaluating nursing attitude, skills, and health guidance. A three-level rating system (very satisfied, satisfied, and dissatisfied) was adopted. Nursing satisfaction was calculated as: (Very satisfied cases + satisfied cases)/total cases × 100%.

Complications: Postoperative cases of infection, flap necrosis, and hematoma were recorded and analyzed.

Statistical analysis

Analyses were performed using SPSS 26.0. Measurement data (e.g., age, disease duration) were expressed as mean ± SD and compared between the observation and control groups using the Student’s t-test. Categorical data (e.g., gender, satisfaction), were summarized as n (%) and analyzed with the χ² test. Statistical significance was defined as P < 0.05.

RESULTS

General data comparison

Comparative analysis showed balanced distributions of age, gender, illness duration, and other baseline data between groups, indicating good comparability (P > 0.05; Table 1).

Table 1 Comparison of general data, mean ± SD.

Indicators	Control group (n = 40)	Observation group (n = 40)	t/χ²	P value
Age (years)	15.62 ± 5.31	16.15 ± 4.89	0.478	0.634
Gender (male/female), n	22/18	23/17	0.050	0.823
Illness duration (years)	8.25 ± 3.12	7.98 ± 2.87	0.401	0.689

Comparative analysis of preoperative and postoperative SAS and SDS scores between groups

Preoperative SAS and SDS scores did not differ significantly between groups one day before surgery (P > 0.05). By the 1-month follow-up, both groups showed decreased from preoperative levels (P < 0.05), with the observation group exhibiting significantly lower scores than controls (P < 0.05; Table 2).

Table 2 Pre- and postoperative Self-Rating Anxiety Scale and Self-Rating Depression Scale scores in both groups, mean ± SD.

Indicators	Time	Control group (n = 40)	Observation group (n = 40)	t	P value
SAS score	1 day preoperatively	56.32 ± 5.18	55.98 ± 4.96	0.305	0.761
	1 month postoperatively	45.21 ± 4.35	36.87 ± 3.89	9.253	0.000
SDS score	1 day preoperatively	54.67 ± 4.89	54.23 ± 5.02	0.412	0.681
	1 month postoperatively	43.56 ± 4.12	34.21 ± 3.67	10.587	0.000

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Comparative analysis of SES scores pre- and post-intervention

Baseline SES measurements showed no significant inter-group differences in total score, mean positive item score, or mean reverse-scored negative item score (P > 0.05). By 1 month postoperatively, all scores had improved in both groups (P < 0.05). The observation group’s total score (36.89 ± 2.56) was significantly higher than the control group’s (30.12 ± 2.87) (t = 11.234, 12.547, 13.109; P < 0.05; Table 3), and all item averages were likewise significantly higher (P < 0.05).

Table 3 Intergroup comparison of self-esteem scores pre- and post-surgery, mean ± SD.

Indicators	Time	Control group (n = 40)	Observation group (n = 40)	t	P value
Total SES score	1 day preoperatively	25.36 ± 3.21	24.98 ± 3.05	0.567	0.571
	1 month postoperatively	30.12 ± 2.87	36.89 ± 2.56	11.234	0.000
Mean score of positive items	1 day preoperatively	2.45 ± 0.32	2.39 ± 0.28	0.876	0.382
	1 month postoperatively	2.89 ± 0.25	3.56 ± 0.21	12.547	0.000
Mean score of negative items	1 day preoperatively	2.62 ± 0.35	2.58 ± 0.31	0.542	0.589
	1 month postoperatively	3.01 ± 0.29	3.72 ± 0.24	13.109	0.000

SES: Self-Esteem Scale.

Pre- and postoperative quality of life comparison

Preoperative baseline quality of life scores - including total score and the physiological, psychological, and social domains - showed no significant between-group differences (P > 0.05). By the 1-month postoperative follow-up, both groups demonstrated statistically significant improvements from baseline values (P < 0.05). The observation group’s total score (82.56 ± 3.76) and domain-specific scores were significantly higher than those of the control group (70.12 ± 4.87; t = 12.837, 10.562, 14.215, and 15.328; P < 0.05; Table 4).

Table 4 Pre- and post-operative quality of life score assessments for both groups, mean ± SD.

Indicators	Time	Control group (n = 40)	Observation group (n = 40)	t	P value
Total	1 day preoperatively	62.35 ± 5.21	61.89 ± 4.98	0.421	0.675
	1 month postoperatively	70.12 ± 4.87a	82.56 ± 3.76a	12.837	0.000
Physiological function	1 day preoperatively	65.21 ± 4.78	64.89 ± 5.03	0.312	0.755
	1 month postoperatively	72.34 ± 4.12a	81.67 ± 3.54a	10.562	0.000
Psychological function	1 day preoperatively	58.76 ± 5.34	57.98 ± 5.12	0.689	0.492
	1 month postoperatively	65.43 ± 4.56a	78.92 ± 3.87a	14.215	0.000
Social function	1 day preoperatively	59.32 ± 5.11	58.76 ± 4.98	0.523	0.602
	1 month postoperatively	66.78 ± 4.32a	80.12 ± 3.65a	15.328	0.000

^aP < 0.05 vs 1 day preoperatively in the same group.

Comparative analysis of nursing care satisfaction

In the control group, 18 patients very satisfied, 15 satisfied, and 7 dissatisfied; in the observation group, 25 were very satisfied, 14 satisfied, and 1 dissatisfied. Overall satisfaction in the observation group reached 97.50% (39/40), higher than the 82.50% (33/40) observed in the control group (P < 0.05; Table 5).

Table 5 Patient satisfaction scores across groups, n (%).

Groups	Very satisfied	Satisfied	Dissatisfied	Satisfaction	χ2	P value
Control group (n = 40)	18 (45.00)	15 (37.50)	7 (17.50)	82.50	5.000	0.025
Observation group (n = 40)	25 (62.50)	14 (35.00)	1 (2.50)	97.50	-	-

Comparison of complication rates

In the control group, 3 infections, 2 flap necroses, and 3 hematomas occurred, whereas in the observation group there was 1 infection, 0 flap necrosis, and 1 hematoma. The complication rate in the observation group was 5.00% (2/40), substantially lower than the control group’s 20.00% (8/40) (P < 0.05; Table 6).

Table 6 Comparative analysis of complication occurrence in two groups, n (%).

Groups	Infection	Flap necrosis	Hematoma	Total incidence	χ2	P value
Control group (n = 40)	3 (7.50)	2 (5.00)	3 (7.50)	20.00	4.114	0.043
Observation group (n = 40)	1 (2.50)	0 (0.00)	1 (2.50)	5.00	-	-

DISCUSSION

This study showed that integrating personalized psychological counseling into comprehensive perioperative nursing for patients undergoing TAR alleviated emotional distress, enhanced self-esteem and quality of life, increased nursing satisfaction, and reduced postoperative complications. These findings align with the evidence that perioperative psychological intervention promotes recovery by reducing stress reactions through targeted psychological support, thereby optimizing treatment compliance and physiological healing.

From a psychological intervention perspective, the observation group’s marked reduction in SAS and SDS scores and higher SES outcomes confirm that personalized psychological counseling effectively mitigates emotional distress and strengthens self-esteem. Layered intervention strategies - such as game-based therapy for pediatric patients and case-focused explanations for adults - matched age-specific cognitive needs and addressed limitations inherent in standardized nursing communication. Intraoperative nonverbal support (e.g., eye contact, gentle reassurance) and postoperative adjustments based on rehabilitation progress further reflect the interactive health education model proposed by Djuwitaningsih and Setyowati[9], underscoring that individualized and continuous psychological intervention is central to optimizing outcomes.

We also found that 3 infections, 2 flap necroses, and 3 hematomas occurred in the control group, whereas the observation group had 1 infection, 0 flap necrosis, and 1 hematoma. The overall complication rate in the observation group was 5.00% (2/40), markedly lower than the control group’s 20.00% (8/40). This reduction may be related to the positive immune-regulating effects of improved psychological well-being. Chronic anxiety can elevate cortisol levels, suppress immune cell activity, and increase infection susceptibility[10]. In this study, personalized psychological counseling likely enhanced patients’ resistance to infection by reducing stress responses. Meanwhile, the nursing plan of the observation group integrated essential measures such as posture management and drainage monitoring. For instance, combining strict 24-hour postoperative bed rest with early, quantified out-of-bed activity aligned with the principle of “enhanced recovery” proposed by Wang et al[11], improved posture coordination through psychological encouragement, and reduced posture-related complications such as flap necrosis. In addition, the use of a self-made ear protective cover provides physical protection for the reconstructed ear; together with psychological intervention, this formed a dual physiological-psychological safeguard that further lowered accidental injury risk[12].

The higher nursing satisfaction observed reflects how personalized services improves doctor-patient relationships. Traditional nursing typically relies on standardized health education, whereas the approach used in this study met patients’ and families’ information needs through one-to-one follow-up, dynamic WeChat communication, and combined paper-electronic education materials. Adaptive guidance for patients traveling from other regions also reflects a patient-centered philosophy[13]. Furthermore, postoperative emotional support - such as sand-tray games and group birthday celebrations - alleviated patients’ loneliness during hospitalization and helped lay the groundwork for rebuilding social functioning[14].

From a technical integration standpoint, this study incorporated personalized psychological counseling with specialized nursing techniques, including laser hair removal and scar intervention, forming a coordinated psychological-physiological-aesthetic intervention framework. Improving the appearance of reconstructed ears through laser treatment can enhance patients’ self-confidence, while psychological counseling helps them to adjust to appearance changes during recovery. Together, these strategies increase overall treatment satisfaction. This integrated model addresses the shortcomings of single-modality nursing and offers a new direction for managing complex plastic surgery cases[15]. Nevertheless, generalizability is limited by the modest sample size and short follow-up, hindering evaluation of long-term psychological effects on restored ear function. Larger, multi-center studies with extended follow-up are therefore required.

However, this study still have several limitations. First, the small sample size limits the universality of the findings. Second, aside from psychological changes in children, objective indicators such as pain levels and inflammation markers were not evaluated. Third, the absence of long-term follow-up means some younger patients’ later psychological changes remain unknown. Thus, well-designed studies with a large sample size and long-term follow-up are needed to further validate these results.

CONCLUSION

Personalized psychological counseling can effectively optimize perioperative nursing outcomes in TAR through precise, full-cycle psychological support. Its combined application with specialized nursing techniques warrants broader clinical application.