Maintaining Ear Aesthetics in Helical Rim Reconstruction

Taylor, James M.; Rajan, Ruchika; Dickson, John K.; Mahajan, Ajay L.

doi:10.1097/sap.0b013e3182610aec

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…In the present study, the vascular pattern of the arterial auricular blood supply was examined using the 'Spalteholz' method, a non-invasive technique that renders the entire ear transparent and enables qualitative and quantitative analyses. It does not rely on any type of dissection, which always includes the removal of valuable tissue and risks accidental damage to small arteries, and it also avoids the use of corrosion procedures that might damage delicate vessels (Steffanoff, 1948;Taylor et al 2014). Several previous studies suggested that the main parts of the auricle including the helical rim are supplied by the PAA (Parkhouse & Evans, 1985;Park et al 1992;Imanishi et al 1997;Park & Roh, 2002;Pinar et al 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the size and depth of the tissue defect, reconstructive options range from simple wedge resections (Radonich et al 2002) to highly sophisticated posteriorly based chondro-cutaneous advancement flaps (Antia & Buch, 1967). Other accepted techniques include the use of pre-auricular flaps (Lawson, 1984), post-auricular flaps (Lewin, 1950), banner flaps (Crikelair, 1956), converse tunnel flaps (Converse, 1958a,b), mastoid tubed-pedicle flaps (Steffanoff, 1948), and unilateral or bilateral helical rim advancement flaps (Fata, 1997;Tezel & Ozturk, 2011;Taylor et al 2014).…”

Section: Introductionmentioning

confidence: 99%

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Reevaluation of the arterial blood supply of the auricle

Zilinsky

Erdmann

Weissman³

et al. 2016

Journal of Anatomy

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The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial network. However, recent findings reveal a systematic pattern as opposed to the present concepts. Therefore, we designed this study to assess the arterial vascular pattern of the auricle in order to provide reliable data about the vascular map required for surgical interventions. Sixteen human auricles from eight body donors (five females/three males, 84.33 ± 9.0 years) were investigated using the unique 'Spalteholz' method. After arterial injection of silicone, a complete transparency of the tissue was achieved and the auricular arteries and branches were visible. Qualitative and quantitative evaluation of the arterial vascular pattern was performed. The superior and the inferior anterior auricular artery provided the vascular supply to the helical rim, forming an arcade, i.e. helical rim arcade. On the superior third of the helical rim another arcade was confirmed between the superior anterior auricular artery and the posterior auricular artery (PAA), i.e. the helical arcade. The perforators of the PAA were identified lying in a vertical line 1 cm posterior to the tragus, supplying the concha, inferior crus, triangular fossa, antihelix and the earlobe. The results of this study confirmed the constant presence of the helical rim arcade (Zilinsky-Cotofana), consistent perforating branches of the PAA, and the helical arcade (Erdman), and will help and guide physicians performing auricular surgeries toward fast and simple procedures with optimal patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reevaluation of the arterial blood supply of the auricle

Zilinsky

Erdmann

Weissman³

et al. 2016

Journal of Anatomy

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“…3 When reconstructing this area it is crucial to avoid ear deformation, due to the importance of aesthetics and functionality of the site. 4 The previously presented flap allows minor modifications of the marking's shape in order to adapt the flap to the patient's contralateral ear, mimicking the helix's original shape and size. 1,5 It, therefore, successfully preserves both cosmetic and functional purposes of the outer ear (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…Surgical excisions on this site often imply loss of the underlying cartilage due to tumour infiltration, leaving a full‐thickness defect that can be challenging to reconstruct 3 . When reconstructing this area it is crucial to avoid ear deformation, due to the importance of aesthetics and functionality of the site 4 …”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a full‐thickness upper third defect of the helix ear using a single‐stage chondrocutaneous composite transposition flap

et al. 2022

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The external ear is a crucial part of the ear's anatomy for both functional and aesthetic purposes. We present a defect after the extirpation of an invasive squamous cell carcinoma, where the final defect involved the superior third of the outer ear, missing both cartilage and skin. The regional chondrocutaneous composite transposition flap of the ipsilateral auricular concha is a one‐stage technique that successfully preserves the helical rim's shape and size.

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“…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. The Antia-Buch flap, which is the standard flap used for helical advancement, 3 is a good option for helix defects as the helix has more curves and folded structures on its superior-most aspect.…”

mentioning

confidence: 99%

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

Evin,

Evin

2023

Ann Plast Surg

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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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Maintaining Ear Aesthetics in Helical Rim Reconstruction

Abstract: This technique reduces cupping and does not make the ear as prominent as it may do after a conventional wedge resection and results in high patient satisfaction.

Cited by 13 publications

References 13 publications

Reevaluation of the arterial blood supply of the auricle

Reevaluation of the arterial blood supply of the auricle

Reconstruction of a full‐thickness upper third defect of the helix ear using a single‐stage chondrocutaneous composite transposition flap

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

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