Periosteal Flap Technique for Elevation of the Pinna in Microtia

Abstract

he ear is a defining feature of the human face. It is considered one of the most important landmarks for a harmonious and aesthetically pleasing countenance. For any facial plastic surgeon, total auricular reconstruction is a formidable challenge because of the unique architectural topography of the ear. Any reconstructive surgical procedure aims for precise duplication of the missing portion. The ability of the facial plastic surgeon to reconstruct characteristics of the normal ear, including size, location, orientation, and anatomic landmarks, is important. If 1 or more of these features are missing, the ear will appear abnormal. 1 One of the goals of treatment of microtia is to create a well-defined postauricular sulcus.Many techniques for elevation of the pinna in cases of microtia have been described. These techniques range from simple elevation of the pinna using split-thickness skin grafts to transplanting cartilage and covering it with a temporal parietal fascia flap. This study presents our experience with a novel periosteal flap for elevation of the pinna in patients with microtia. Methods Report of Cases Case 1A 39-year-old man with right-sided grade III microtia and congenital auricular atresia had undergone more than 15 operations at other institutions for correction of the microtia and congenital auricular atresia (Figure 1). The result was unsatisfactory for the patient and his family, with multiple scars in the reconstructed auricle and the temple. Our surgical plan was to insert a tissue expander (350-mL crescentshaped implant; Mentor) under the skin of the previously IMPORTANCE For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts).OBSERVATIONS The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting. CONCLUSIONS AND RELEVANCEThe periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.

Total ear reconstruction: The role of bilateral triangular post-auricular flaps for creation of the cephaloauricular sulcus

“…The use of fascial flaps to cover the cartilage block, whether innominate fascial flap as described by Nagata 15 , anteriorly based as described by Yoshimura et al 6 , or posteriorly based combined fascial and periosteal flap as described by Siegert et al 16 , provides vascularity to the transplanted framework so that it can accept skin grafts.…”

Modular Component Assembly Approach to Microtia Reconstruction

“…(July 2015) investigates a novel method for improved elevation and stabilization of the pinna in autologous microtia repair using a new periosteal flap technique. 14 …”