Reconstruction of Extensive Auricular Defects Using a Retroauricular Artery Perforator–Based Propeller Flap

Abstract

Background Various local techniques have been successfully used for the reconstruction of auricular defects. However, most local techniques are not suitable for extensive auricular defects. The aim of this study is to investigate the utility of a retroauricular artery perforator–based propeller flap for the reconstruction of extensive auricular defects by evaluating aesthetic outcomes using objective and quantitative parameters. Methods Twenty-one patients with extensive full-thickness and partial-thickness defects were treated with retroauricular artery perforator–based propeller flaps harvested from the mastoid and neck regions. The surgical procedures were performed using single-stage reconstruction in postauricular partial-thickness defects and 2-stage reconstruction in full-thickness auricular defects. Levels of final satisfaction and tissue matching as well as donor scar perception were evaluated by the patients and objective observers. Results The original sizes and projections of the auricles were achieved. The color, texture, and thickness of the flaps matched well with the adjacent auricles. The vast majority of the patients and observers were very satisfied with the surgical outcome. Conclusions Retroauricular artery perforator–based propeller flaps may preserve the size and projection in both partial- and full-thickness extensive defects of the auricle. With this procedure, there was also excellent matching of the color, texture, and thickness of the flap with the adjacent tissue, as well as acceptable levels of donor scarring, thereby achieving satisfactory aesthetic outcomes.

Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap

“…A combination of cartilage grafts and local cutaneous flaps provide abundant tissue for full-thickness helical defects. 12,18,28 However, the use of this combination is limited due to the restricted mobility of the flap in relation to the projected helix, 28 the requirement for extensive dissection of the hair-bearing scalp, 28,29 donor-side morbidity, the need to skin-graft the donor defect, 28,30 bulky reconstruction and the need for revision, 12,28,31 and multistage surgeries. 6,12,18,28,30 Therefore, redistributing techniques for the remaining auricular tissues provide ideal tissue for full-thickness helical defects with similar characteristics.…”

“…12,18,28 However, the use of this combination is limited due to the restricted mobility of the flap in relation to the projected helix, 28 the requirement for extensive dissection of the hair-bearing scalp, 28,29 donor-side morbidity, the need to skin-graft the donor defect, 28,30 bulky reconstruction and the need for revision, 12,28,31 and multistage surgeries. 6,12,18,28,30 Therefore, redistributing techniques for the remaining auricular tissues provide ideal tissue for full-thickness helical defects with similar characteristics. The auricle has 2 laxity tissue banks for flap surgery in the earlobe and postauricular area, and various local cutaneous and chondrocutaneous flaps have been widely used for helical defects from these donor areas.…”

“…Reconstruction of full-thickness helical defects presents considerable challenges. 1,4,6,7,10,[12][13][14][16][17][18] The goals of helical reconstruction are to provide 'like tissue' reconstruction with similar color, texture, and thickness; repair of the 3-dimensional cartilage framework for stable structural support; and normal auricle dimensions and anatomical landmarks in a 1-stage reconstruction. 4,[6][7][8][10][11][12][13]17,19 Various techniques have been applied for helical reconstruction; however, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes.…”

“…Auricular defects resulting from trauma, human bites, burns, and surgical resection of skin pathologies most commonly occur in the helix 1–14 . Helical defects typically involve the full thickness of the skin and cartilage, resulting in auricle asymmetry and significant esthetic, functional, and psychosocial issues, due to the highly visible location of the helix and its structural support role when wearing glasses, masks, and piercings 9,10,14,15 …”

“…Reconstruction of full-thickness helical defects presents considerable challenges 1,4,6,7,10,12–14,16–18 . The goals of helical reconstruction are to provide ‘like tissue’ reconstruction with similar color, texture, and thickness; repair of the 3-dimensional cartilage framework for stable structural support; and normal auricle dimensions and anatomical landmarks in a 1-stage reconstruction 4,6–8,10–13,17,19 …”