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Poissonnet G, Poissonnet V, Dassonville O, Bozec A, Culié D. Partial Central Anterior Reconstruction of the Auricle with One-Stage Combined Retroauricular Flaps. Plast Reconstr Surg 2024; 153:713-715. [PMID: 37141494 DOI: 10.1097/prs.0000000000010611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
SUMMARY Basal cell carcinomas of the central anterior area of the auricle limited to the antihelix and scapha without peripheral infiltration of the helix are not uncommon. Resection is rarely transfixing, but resection of the underlying cartilage is often required. The complex anatomy of the ear and the lack of local tissue available makes its reparation challenging. Defects of antihelix and scapha require special reconstructive techniques, taking into account skin structure and the three-dimensional architecture of the ear. The reconstruction usually consists of full-thickness skin grafting or anterior transposition flap, requiring an extended skin resection. The authors describe a one-stage technique that uses a pedicled retroauricular skin flap turned over the anterior defect, followed by immediate closure of the donor site with a transposition or a bilobed retroauricular skin flap. The one-stage combined retroauricular flap reparation optimizes cosmetic outcome and reduces the risk of successive surgical procedures.
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Affiliation(s)
- Gilles Poissonnet
- From the Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur
| | - Valentine Poissonnet
- Département de Chirurgie ORL et Cervico-faciale, Centre Hospitalier Universitaire de Toulouse
| | - Olivier Dassonville
- From the Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur
| | - Alexandre Bozec
- From the Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur
| | - Dorian Culié
- From the Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur
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Caretto AA, Colavincenzo C, Gentileschi S. Tunnelised superiorly based preauricular flap and conchal cartilage graft for antihelix reconstruction. BMJ Case Rep 2024; 17:e259025. [PMID: 38350704 PMCID: PMC10868292 DOI: 10.1136/bcr-2023-259025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
Reconstruction of a full-thickness defect of the auricle's anterior surface represents a challenge for plastic surgeons. This report describes the case of a man in his 70s, who underwent radical excision of a squamous cell carcinoma involving his right antihelix. We adopted an innovative approach for the reconstruction of the antihelix, using a tunnelled preauricular flap reinforced with an ipsilateral concha cartilage graft. The flap's base was de-epithelialised, allowing a single-stage procedure. Three months postoperation, no complications arose, and the scars at the donor site were effectively concealed. The aesthetic result was excellent, thanks to the perfect colour match, symmetry, shape of the auricle and the long-lasting integrity of the antihelical structure.This technique allows for accurate reconstruction of the convoluted surface of the auricle in cases of full-thickness defects of the antihelix, without the need to harvest cartilage from other donor sites and in a single surgical procedure.
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Affiliation(s)
- Anna Amelia Caretto
- Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Chiara Colavincenzo
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Gentileschi
- Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
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3
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Evin N, Evin SG. Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap. Ann Plast Surg 2024; 92:198-207. [PMID: 37830506 DOI: 10.1097/sap.0000000000003677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects. METHODS Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers. RESULTS The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001). CONCLUSIONS Reconstruction of full-thickness helical defects requires "like tissue" characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.
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Affiliation(s)
- Nuh Evin
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Seyda Guray Evin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
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Desisto NG, Ortiz AS, Yang SF, Stephan SJ, Patel PN. State of the Evidence for Facial Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:220-229. [PMID: 36603830 DOI: 10.1055/a-2008-2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs micrographic surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs micrographic surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data are discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.
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Affiliation(s)
- Nicole G Desisto
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra S Ortiz
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shiayin F Yang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Affiliation(s)
- Xiaoting Cheng
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | | | - Bing Chen
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Yilai Shu
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Sakiyama PH, Ferrari TA, Garbin RR, Tarlé RG. Old but gold - Antia and Buch chondrocutaneous advancement flap for helical reconstruction: a series of cases. An Bras Dermatol 2022; 97:835-837. [PMID: 36075799 PMCID: PMC9582892 DOI: 10.1016/j.abd.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Raíssa Rigo Garbin
- Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, PR, Brazil
| | - Roberto Gomes Tarlé
- Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, PR, Brazil; Discipline of Dermatology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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A Retrospective Study on Single-Stage Reconstruction of the Ear following Skin Cancer Excision in Elderly Patients. J Clin Med 2022; 11:jcm11030838. [PMID: 35160289 PMCID: PMC8836452 DOI: 10.3390/jcm11030838] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Ear reconstructive surgery aims to solve the deformities caused by cancer excision. Despite the numerous surgical procedures described, recreating the complex anatomy of the ear still represents a challenge, particularly for young surgeons. The purpose of this exploratory pilot study is to review our experience with single stage reconstruction of the partial defects of the auricle, and propose an algorithm based on defect size, location, and characteristics. We retrospectively reviewed patients who underwent ear reconstruction after cancer excision at our institution between February 2018 and November 2020. The data collected included patients’ demographics, defect characteristics, reconstructive technique used, complications, and outcomes. The patients were evaluated at a minimum follow-up time of 12 months. Forty-six patients were included in the study. The most common cause for ear reconstruction was basal cell carcinoma. The mean area of defect was 4.3 cm2 and the helix was the most frequent location of defect. Two patients experienced post-operative complications. At the one-year follow-up, difference in skin pigmentation was reported in 10 cases, a depressed contour of the ear was found in 4 cases, and moderate ear asymmetry was found in 11 cases. No patient needed a secondary procedure. In conclusion, the proposed reconstructive algorithm represents a reconstructive indication that is simple and characterized by low complication rates and good outcomes for both the patient and the surgeon.
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Ghodke A, Mims MM, Meyer M, Clark JM, Shockley WW. Aesthetic Helical Reconstruction: Postauricular Flap with Primary Skin Graft. Facial Plast Surg Aesthet Med 2021; 24:499-500. [PMID: 34847722 DOI: 10.1089/fpsam.2021.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ameer Ghodke
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mark M Mims
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Meredith Meyer
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Joseph Madison Clark
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William W Shockley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases. Plast Reconstr Surg 2021; 148:171-182. [PMID: 34181615 DOI: 10.1097/prs.0000000000008098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasal defects following Mohs resection are a reconstructive challenge, demanding aesthetic and functional considerations. Many reconstructive modalities are available, each with varying utility and efficacy. The goal of this study was to provide an algorithmic approach to nasal reconstruction and illustrate lessons learned from decades of reconstructing Mohs defects. METHODS A retrospective review was conducted of consecutive patients who underwent nasal reconstruction after Mohs excision from 2003 to 2019 performed by the senior author (J.F.T.). Data were collected and analyzed regarding patient and clinical demographics, defect characteristics, reconstructive modality used, revisions, and complications. RESULTS A total of 2553 cases were identified, among which 1550 (1375 patients) were analyzed. Defects most commonly affected the nasal ala (48.1 percent); 74.8 percent were skin-only. Full-thickness skin-grafts were the most common reconstructive method (36.2 percent); 24.4 percent of patients underwent forehead flaps and 17.0 percent underwent nasolabial flaps. The overall complication rate was 11.6 percent (n = 181), with poor wound healing being most common. Age older than 75 years, defects larger than 2 cm2, and active smoking were associated with increased complication rates. CONCLUSIONS Nasal reconstruction can be divided based on anatomical location, and an algorithmic approach facilitates excellent results. Although local flaps may be suitable for some patients, they are not always the most aesthetic option. The versatility and low risk-to-benefit profile of the forehead flap make it a suitable option for elderly patients. Although reconstruction is still safe to be performed without discontinuation of anticoagulation, older age, smoking, and large defect size are predictors of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Bittner GC, Kubo EM, Fantini BDC, Cerci FB. Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases. An Bras Dermatol 2021; 96:408-415. [PMID: 34090728 PMCID: PMC8245722 DOI: 10.1016/j.abd.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 01/07/2023] Open
Abstract
Background The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact. Objective To describe the authors’ experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods. Methods Retrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years. Results One hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection). Study limitations Retrospective design and the absence of long-term follow-up of some cases. Conclusions The dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.
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Affiliation(s)
- Guilherme Canho Bittner
- Dermatology Service, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil; Private Practice, Campo Grande, MS, Brazil.
| | | | - Bruno de Carvalho Fantini
- Dermatology Service, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Felipe Bochnia Cerci
- Dermatology Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Postgraduate Program in Internal Medicine and Health Sciences, Universidade Federal do Paraná, Curitiba, PR, Brazil; Private Practice, Curitiba, PR, Brazil
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Li D, Zhang R, Zhang Q, Xu Z, Xu F, Li Y, Chen X. Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective Study. Aesthetic Plast Surg 2020; 44:1545-1552. [PMID: 32300879 DOI: 10.1007/s00266-020-01711-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skin grafts, frequently used for ear elevation in ear reconstructions, may suffer from color mismatches, scar hypertrophy, secondary contraction, and auricular sulcus depth differences. To determine the most suitable donor area, we compared the contralateral postauricular area, groin, and scalp as potential donor sites. METHODS Since 2008, we have used three donor sites for obtaining skin grafts used in ear reconstructions. Full-thickness groin skin, split-thickness grafts from the scalp, and contralateral postauricular and groin composite full-thickness skin grafts were used in 202, 231, and 195 patients, respectively. Photographic assessments were used to assess color matching, sulcus depth, cranioauricular angle symmetry, and flatness of the skin grafts; surgical complications were also documented. RESULTS Among the three donor sites, there were no significant differences in the color matching scores (p = 0.456). The scalp donor scores had significantly lower mean scores for sulcus depth and symmetry and for graft flatness scores than the other donor sites. The assessment scores between the groin and postauricular donor groups were similar. Each donor site was associated with some surgical complications. However, postauricular skin, when combined with groin skin, demonstrated the best cosmetic results and the fewest complications. CONCLUSION All three donor sites are viable options for skin graft donor sites in ear elevation surgeries. Although the advantages and disadvantages of each site should be explained to the patient, the ultimate donor site selection may be determined according to patient and surgeon preferences. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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