Superficial temporal artery capillary perforator-based island flap for conchal bowl and external auditory canal reconstruction

Superior temporo-auricular perforator flap for reconstruction of extensive conchal defects

Anterior auricular concha reconstruction has always been a challenge for the plastic surgeon. The goal of optimal reconstruction is to achieve a natural aesthetic outcome taking care to avoid meatal stenosis and distortion. We present a new technique for reconstruction of large anterior conchal defects with meatal involvement using a perforator flap harvested from the superior auricular region. All patients undergoing post-oncological reconstruction with superior temporo-auricular perforator flap were retrospectively analysed. A handheld Doppler evaluation was performed prior to surgery. Follow-up at 1, 3, 6 and 12 months was carried out. Nine patients were evaluated. No partial or total vascular complications were observed. No relapse of the tumour and meatal stenosis developed. Eight patients were very satisfied with the aesthetic outcome. Only one patient was not completely satisfied due to the presence of hair at the level of reconstructed site.

The superior temporo-auricular flap is a good alternative to flaps harvested from the retro-auricular region and should be considered as a primary choice for reconstruction of extensive defects of the conchal and external meatus area.

Propeller flaps in partial ear reconstruction: a case series

Background

Ear defect reconstruction still remains a surgical challenge today. Proper reconstruction should result in correction of the deformity with minimum morbidity with the aim of achieving the most esthetically pleasing outcome possible. Herein, we present our clinical experience with propeller flap reconstruction of external ear defects with a focus on indications and surgical technique.

Methods

Fourteen patients underwent surgery at our Plastic Surgery Unit between January 2015 and October 2019. After identifying perforators with a handheld Doppler ultrasound, a tailor-made flap was designed for each patient. Following tumor excision, dissection of the pedicle and of the remaining flap was performed with the aid of surgical loops. Flap in-setting and donor site closure were final steps.

Results

Flaps have survived in their entirety in almost all our patients (13/14) maintaining optimal color and elasticity and showing no complications. In one case, a superficial distal necrosis was observed and, in another patient, tumor recurrence took place.

Conclusions

Propeller flaps offer great advantages when used in ear reconstruction ensuring excellent esthetic results with a one-stage technique. Nevertheless, it must be kept in mind that good dissection skills are required in order to avoid complications.

Level of evidence: Level IV, Therapeutic study.