1
|
Li D, Sun J, Zhang R, Xu Z, Zhang Q, Xu F, Li Y, Chen X. Firm elevation of the auricle in reconstruction of microtia with a retroauricular fascial flap wrapping two titanium plate struts. J Plast Reconstr Aesthet Surg 2023; 83:134-140. [PMID: 37276731 DOI: 10.1016/j.bjps.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Reconstruction of the cephaloauricular sulcus in patients with microtia in ear reconstructions remains challenging. Costal cartilage and other support materials wedge were used for ear elevation. Each material has its disadvantages. To reconstruct a stable cephaloauricular sulcus and reduce costal cartilage harvesting, we used two titanium plate struts to support the costal cartilage framework. METHODS A titanium plate strut was designed. The angle of the strut was 60°, the arm length was 0.8 cm, and the width was 0.5 cm. The thickness was 0.6 mm. Four small pores are formed on the titanium plate. The implanted framework was separated from the underlying bed. Two titanium plate struts were fixed on the raised ear framework, tendon, and periosteum, and then wrapped with a turned-over retroauricular fascia flap. The raw surface was covered with a split-thickness skin graft, harvested from the scalp. RESULTS From 2019 to 2022, 51 patients underwent second-stage operations. All patients were followed up for a minimum of 6 months. The auricular projection was well-maintained, and the cephaloauricular sulcus of the constructed auricle was acceptable in 50 patients. There was one infection, and the titanium plate struts were removed, which resulted in shrinking cephaloauricular angles. CONCLUSIONS Titanium plate is effective as a supportive material to obtain the proper and firm projection of the constructed auricle. It provides a new option for patients whose costal cartilage volume is insufficient or who do not want to have the costal cartilage harvested again.
Collapse
Affiliation(s)
- Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| | - Jiayuan Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China.
| | - Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| | - Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| | - Xia Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai 200011, China
| |
Collapse
|
2
|
Ibrahiem SMS, Farouk A. Total ear reconstruction: The role of bilateral triangular post-auricular flaps for creation of the cephaloauricular sulcus. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Adham Farouk
- Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
4
|
Zhang Q, Zhang R, Xu F, Jin P, Wu J, Li D, Chin W. Firm elevation of the reconstructed auricle with a retroauricular fascial flap wrapping an EH (a mixture of epoxide acrylate malelic and hydroxyapatite) composite wedge. J Plast Reconstr Aesthet Surg 2010; 63:1452-8. [DOI: 10.1016/j.bjps.2009.07.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Revised: 07/17/2009] [Accepted: 07/26/2009] [Indexed: 10/20/2022]
|
5
|
Datta G, Carlucci S. Reconstruction of the retroauricular fold by 'nonpedicled' superficial mastoid fascia: details of anatomy and surgical technique. J Plast Reconstr Aesthet Surg 2009; 61 Suppl 1:S92-7. [PMID: 18675604 DOI: 10.1016/j.bjps.2008.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 05/14/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
During ear reconstruction, it is often difficult to achieve a good projection of the new ear. This is due to the retraction of retroauricular tissues, and the use of a cartilage wedge and superficial temporal fascia is frequently needed to elevate the ear framework. The aim of this article is to identify, by cadaver dissection, the anatomical structures of the retroauricular and mastoid regions and also to demonstrate the possibility of increasing the size of the superficial mastoid fascia by defibrating and cutting up its structure. The cartilage wedge is then inserted into a three-dimensional fascial environment. This allows reconstruction of the retroauricular fold with 'nonpedicled' fascia and to have a firm, stable ear elevation without sacrificing the temporal fascia. Nine ear reconstructions were performed using this technique and no major complications occurred; however, one procedure was complicated by a limited necrosis of the skin graft. In all cases we obtained a good and persistent elevation of the ear, as well as a well-defined fold, with the possibility of wearing glasses. Symmetry was satisfactory and aesthetic results were pleasant for all treated patients. This simple procedure allows one to obtain a good projection of the ear without involving the use of the superficial temporal fascia, which in addition is very useful in case of eventual complications such as cartilage extrusion.
Collapse
Affiliation(s)
- Giacomo Datta
- Department of Plastic Surgery, University of Turin, Italy
| | | |
Collapse
|
6
|
Tai Y, Tanaka S, Fukushima J, Kizuka Y, Kiyokawa K, Inoue Y, Yamauchi T. Refinements in the Elevation of Reconstructed Auricles in Microtia. Plast Reconstr Surg 2006; 117:2414-23. [PMID: 16772950 DOI: 10.1097/01.prs.0000225449.04098.94] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the treatment of microtia, the search has been for surgical techniques that prevent postoperative complications and realize sufficient and stable projection of the constructed ear. METHODS Cartilage was fixed with absorbable synthetic thread instead of wire because wire has a high risk of exposure. A subcutaneous pedicle was added to the concha to prevent skin necrosis. Dead space and hematoma creation were prevented with vacuum aspiration, bolster fixation, and microdrainage with small tubes. A triangular skin flap connecting to the ear lobe was used to prevent shrinkage on the posteroinferior portion of the concha. Projection of the inferior portion of the auricle was supported with a hydroxyapatite-tricalcium phosphate ceramic. RESULTS Our technique was applied to 42 patients, and none of them experienced slip of the fixed cartilage, auricular deformation, skin necrosis, or infections. Shrinkage of the inferior portion of the auricle was minimal, and good projection was obtained. CONCLUSIONS The authors' technique prevents complications and realizes good shape and projection of the auricle in total reconstruction of the auricle. Hydroxyapatite-tricalcium phosphate ceramic is a useful material that complements the cartilage shortage.
Collapse
Affiliation(s)
- Yoshiaki Tai
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
| | | | | | | | | | | | | |
Collapse
|
7
|
Alexander G, Rajacic N, Ibrahim MK, Al-Zamil S, Al-Jamil S. The combined posterior temporoparietal and galeal fascial flap: a new flap in the elevation of the constructed auricle (second stage of microtia correction). BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:582-4. [PMID: 12528998 DOI: 10.1054/bjps.2002.3914] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over the past few years, the technique of elevating the buried ear framework in the second stage of microtia correction has shifted from skin grafting to the use of flaps and cartilage blocks in the retroauricular sulcus. While the temporoparietal fascial flap should be reserved for secondary procedures and the treatment of complications, the mastoid fascial flap is inadequate by itself and needs an additional cartilage graft. Here, we describe a new flap, the combined posterior temporoparietal and galeal fascial flap, for the elevation of the buried ear cartilage. The flap is robust, with a dependable blood supply based on the posterior branches of the superficial temporal artery. In four cases the flap was rolled up and inset into the retroauricular sulcus, while in three cases an additional conchal cartilage graft was inserted into the roll. All the patients had satisfactory ear projection at follow-up 10-14 months postoperatively. We discuss the surgical technique and the advantages of this flap. We believe that this new flap, which has not been described before, has the potential to replace other flaps in the second stage of microtia correction.
Collapse
Affiliation(s)
- G Alexander
- Al-Babtain Centre for Plastic Surgery and Burns, Ibn-Sina Hospital, Safat, Kuwait
| | | | | | | | | |
Collapse
|