Free prepared composite forearm flap transfer for ear reconstruction: Three case reports

Abstract

From 1980 to 1993 there have been five reports of ear replantation or reconstruction using microsurgical techniques. They are A) successful replantation of a completely avulsed ear by microsurgical anastomosis'; B) microsurgical reattachment of totally amputated ears2; C) completely successful replantation of an amputated ear by microvascular anastomosis3; D) microvascular ear replantation with no vein anastomosis4; and E) reconstruction of an avulsed ear by constructing a composite free flap.5 The first four reports of completely avulsed ears were successfully replanted with microvascular anastomosis. The last report was of an avulsed ear whose cartilage was buried into the forearm skin and 6 months later the composite forearm flap was transferred into the ear region by microvascular anastomosis. These reports confirmed that ear reconstruction could be completely successful by microsurgical methods. It must be emphasized that microsurgical ear reconstruction is suitable especially for those patients in whom the ear defect resulted from severe burning or avulsion of scalp with an avulsed ear. In these cases there is no normal tissue around the ear region that can be used for routine local flap reconstruction.From December 1990 to October 1993 we performed 3 cases of successful ear reconstruction using microsurgical methods for 2 patients with burn defects and for 1 patient with an avulsed scalp. SURGICAL METHODSThe surgical procedure is divided into two stages. The composite forearm flap is prepared at the first stage. In the second stage, the composite forearm flap is transferred to the ear region for ear reconstruction.In the first stage, portions of the 6th, 7th, and 8th rib cartilages were removed and carved into a cartilage framework for ear reconstruction. The framework was then buried under the skin of the forearm. In this step, the direction of the reconstructed ear and its relationship between the forearm flap and radial vessels must be considered carefully.More than 3 months later the second stage procedure is performed. The prepared composite cartilage-forearm flap is isolated in the same manner as a free forearm flap. Care must be taken to avoid exposure of the cartilage and to ensure that the vascular pedicle will be long enough. The flap is then transferred to the head, and the vessel anastomoses performed. A split skin graft is used to resurface the back of the reconstructed ear. The defect of the radial artery may be restored by a vein graft and the forearm skin donor site is resurfaced with a full-thickness graft. CASE REPORTS Case 1A 22-year-old male with a burn scar over his left face, temple, and ear region was admitted for repair of his left face and ear (Fig. 1).In December 1990 a lateral thorax flap was transferred to resurface his left face. At the same operation a costal cartilage ear framework was carved and buried into the left forearm just under the skin. Thus, we prepared a composite forearm flap for ear reconstruction. Four months later the second stage was undertaken.In the second p...

''Extracorporeal Loop'' (Blind Loop): An Alternative Microsurgical Technique for Prelaminated Flap Transfer

“…The radial forearm flap is one of the sources for flap prelamination that may be used for nose and ear reconstruction, 11,[13][14][15] as is presented in our cases. Methods of nose and ear reconstruction, with their advantages and disadvantages, are not the theme of this paper.…”

Burned Ear Reconstruction Using the Combination of an Expanded Postauricular Scar Skin Flap and a Postauricular Fascial Flap

“…When neither local skin nor fascia is available in severely burned patients, free flaps such as contralateral superficial temporal fascial flaps and radial forearm fascial flaps are also good choices to cover the framework. 6,16,17 These free flaps are raised with the artery and accompanying veins and anastomosed with the recipient vessels. Unlike the superficial temporal fascial flap, radial forearm fascia has a long pedicle such that an anastomosis can be created in the neck with the superior thyroid artery and vein without an additional vein graft.…”

Burned Ear Reconstruction Using a Prefabricated Free Radial Forearm Flap

“…A disadvantage of this flap is that the reconstructed ear is often too thick and hard. 3 We used a different surgical technique, covering the front and back of the cartilage framework with the forearm flap, and the reconstructed ear was not too thick, compared to some previous cases reported in the literature.…”