Prevention of Recurrence in the Surgical Correction of Cryptotia Using Local Flaps With a Cartilage Wedge Graft

Correction of Cryptotia With Double Z-plasty:Modified Large Z-plasty Technique

Some cases of moderate or severe cryptotia are accompanied by a shortage of the helix. Although various operative techniques for correcting cryptotia have been reported, elongation of the helix is not considered in most of those techniques. In cases of a shortage of the helix, a drooped wide helix like a constricted ear or a cranially and posteriorly hypoplastic ear, which is characteristic of cryptotia, can appear after surgery if the helix has not been elongated. We previously reported a large Z-plasty technique that has become one of the popular techniques for correcting cryptotia. However, satisfactory results are not always achieved by using this technique in cases with a shortage of the helix. We developed a new technique (double Z-plasty) in which a small Z-plasty in the helical rim is added to the usual large Z-plasty technique. An improved helical shape and enlargement of the ear can be achieved by using this technique. Almost all types of cryptotia can be treated by appropriately using the large Z-plasty and double Z-plasty techniques.

Cryptotia Repair Using a Modified V-Y Advancement Flap with Helix Rounding Technique

BACKGROUND

Cryptotia is a common congenital auricular malformation seen in Asian people. To date, multiple surgical procedures have been described for correcting cryptotia. However, the deformity often recurs, presenting as an unclear auriculotemporal sulcus and a malformed helix. The present study aimed to introduce a novel surgical approach to obtain a stable and aesthetic auricular correction in cryptotia patients and to acquire an understanding toward improved surgical management of cryptotia.

METHODS

Twenty-four cryptotia patients (28 ears), who were operated between April 2018 and November 2021, were included in this study. All patients underwent surgical correction for cryptotia using a modified V-Y advancement flap with helix rounding technique, performed by a senior surgeon.

RESULTS

Patients were followed for an average period of 9.4 months (6 to 18 months). Twenty-one patients (87.5%) were satisfied, three (12.5%) were partially satisfied, and none were unsatisfied. Most patients experienced temporary edema as a postsurgical complication, which resulted in a swollen auricle appearance lasting for three to four weeks postoperatively. One patient experienced skin necrosis in one ear on the anterior portion of the upper helix and this was solved by skin grafting.

CONCLUSIONS

The method of surgical correction utilizing a modified V-Y advancement flap with helix rounding technique proved to be a reliable option in cryptotia patients. It can provide stable aesthetic results after cryptotia correction in clinical practice.

LEVEL OF EVIDENCE IV

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Cryptotia recurrence lowering technique with additional acellular dermal matrix graft

BACKGROUND

Cryptotia is a congenital anomaly in which the upper part of the retroauricular sulcus is absent and buried underneath the temporal skin. Various surgical techniques have been reported for the correction of cryptotia following Kubo's V-Y plasty in 1933. Conventional methods using a local skin flap, skin grafting, tissue expansion, Z-plasty, and any of these combined approaches can result in skin deficiency of the upper auricle. The aim of this study was to develop a new method that improves cosmetic results and has fewer complications.

METHODS

This study involved four patients in whom five cryptotia deformities were corrected using V-Y plasty and Z-plasty. After elevation of the flap, acellular dermal matrix (ADM; MegaDerm) that was over 5 mm in thickness was applied to the cephalo-auricular angle and positioned to enhance the projection of the ear. Lastly, the flap was transposed to complete the repair.

RESULTS

Between January 2014 and February 2018, cryptotia correction with ADM graft was performed in four patients. None of the patients developed a recurrence of cryptotia, and there were no postoperative complications such as wound infection, seroma formation, and dehiscence. In addition, the procedures resulted in a favorable cosmetic appearance.

CONCLUSION

Based on these findings, i.e., no recurrence and a favorable cosmetic result, when using an ADM graft, it is suggested that this technique could be an alternative method of cryptotia correction. It could also lessen donor-site morbidity when compared to autologous cartilage grafting and be more cost-effective than using cartilage from a cadaver.

Surgical correction of cryptotia combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap

BACKGROUND

Cryptotia is a common congenital ear deformity in Asian populations. In cryptotia, a portion of the upper ear is hidden and fixed in a pocket of the skin of the mastoid. Here we describe our method for cryptotia correction by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap.

PATIENTS AND METHODS

We developed a new method for correcting cryptotia by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. Following ear release, the full-thickness skin rotation flap is rotated into the defect, and the donor site is covered with an ultra-delicate split-thickness skin graft raised in continuity with the flap.

RESULTS

All patients exhibited satisfactory release of cryptotia. No cases involved partial or total flap necrosis, and post-operative outcomes using this new technique for cryptotia correction have been more than satisfactory.

CONCLUSIONS

Our method of using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap to correct cryptotia is simple and reliable.