Incision and flap design during total auricular reconstruction using a 2-stage strategy

Abstract

Background: Total auricular reconstruction is a challenge for plastic surgeons. Expanded flap method and Nagata's method with autologous costal cartilage are two leading techniques for ear reconstruction. And a two-stage strategy of expanded flap method received attention. In the present study, we report the incision and flap design of this strategy.Methods: In the first stage, an 80 mL kidney-shaped expander was inserted in the mastoid region with the larger pole superiorly. The expander pocket was dissected subcutaneously in the scalp area and subfascially in the lower third region. In the second stage, the expander was removed from a Y-shaped lobule incision on the remanent ear. Then the remnant ear was separated into three flaps: the posterior skin flap, anterior skin flap, and lobule flap. When the framework was fabricated, the base frame and the underlying pad, which enhanced the projection, were fixed together as a whole to provide a more prominent appearance. The framework was totally wrapped into the expanded single flap without free skin grafting. Lobule transposition and tragus construction were performed simultaneously instead of a third-stage surgery. The recipient bed of rotated lobule was resected only to the epidermal layer and the subcutaneous layer was preserved to avoid central necrosis.Results: A total of 21 patients received this strategy to reconstruct ear. With 3 months to 1.5 years of follow-up, 19 patients (90.5%) were satisfied with the reconstructed ears. 3 patients (14.3%) required further modification of reconstructed ear. No serious complications occurred during the procedures.Conclusions: With a Y-shaped incision, three-flap design of remanent ear and lobule rotation to an epidermal-removal area, tissue expander removal and modification of remanent ear can be performed effectively to avoid necrosis and an extra operation.

Comparison of Auricle Reconstruction Using Tissue Expanders With Skin Grafting and Auricle Reconstruction Using Tissue Expanders Without Skin Grafting: A Single-Arm Meta-Analysis

“…A total of 2637 literatures were retrieved. After screening, 29 articles 5–33 were included in this meta-analysis. The articles screening process was shown in Figure 1 (the features of the included literature were shown in Supplementary Digital Content, Table 1, http://links.lww.com/SCS/D421).…”

Comparison of auricle reconstruction with expanded flaps and auricle reconstruction with non-expanded flaps in patients with microtia: A meta-analysis

“…Both the auricle reconstruction with expanded flaps and the auricle reconstruction with non-expanded flaps have advantages and disadvantages. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The auricle reconstruction with expanded flaps is generally not affected by the degree of ear malformation and is suitable for most patients with microtia. Moreover, the expanded flaps have more blood circulation and are easier to survive.…”