A new strategy for total auricular reconstruction using prelamination of an extended retroauricular flap with tissue expansion

Abstract

A new strategy for total auricular reconstruction using prelamination of extended retroauricular flap with tissue expansion, SummaryBackground: To accomplish total ear reconstruction with aesthetic appearance is a great challenge for plastic surgeons worldwide due to insufficient skin coverage. A retroauricular fascia flap and skin graft technique are commonly used, but the results are unsatisfied due to color mismatch, severe edema, and donor site morbidity. Here, we will describe a novel strategy for total ear reconstruction, utilizing an extended retroauricular flap prelaminated with tissue expansion to obtain enough skin for ear reconstruction. Methods: About two months before ear reconstruction, kidney shaped tissue expander was inserted at the mastoid region subcutaneously. The retroauricular skin became enlarged and thinner in 2 months after expansion. Next, the expander was removed and the retroauricular flap was extended by dissecting the surrounding scalp subcutaneously. By mobilizing the scalp-extended retroauricular flap, we could encapsulate the entire framework with thin and non-hair bearing skin. Results: From August 2014 to September 2015, 36 microtia patients had undergone ear reconstruction using the novel strategy. All cases have resulted in satisfactory aesthetics with fine structure, symmetry, maintenance of the auriculocephalic angle. Conclusions: Using our novel strategy, we can obtain satisfactory aesthetic outcome by fully mobilizing the expanded skin without additional morbidities of donor sites. Patients are satisfied with the vivid ear contour and lack of groin scar.

A novel two-stage strategy combing tissue expansion and Nagata`s technique for total auricular reconstruction

“…Many doctors have made potential contributions in tissue expansion to avoid skin grafting, but it still required three or more stages of operations. 14,20 In this study, we introduce a modified method for auricular reconstruction, which is the novel two-stage strategy combing tissue expansion and Nagata`s technique. Firstly, an 80-ml kidney-shaped expander is inserted into the mastoid region.…”

Incision and flap design during total auricular reconstruction using a 2-stage strategy

“…Although controversy around tissue expansion exists, a number of surgeons have successfully employed tissue expansion in the reconstruction of congenital microtia and traumatic auricular defects. In China, ear reconstruction surgeons reported thousands of microtia patients were reconstructed by skin expansion techniques (13,14,(19)(20)(21)(23)(24)(25)(26). Usually, the expanded flap is not large enough to drape the entire framework, so skin grafts and postauricular facial flap elevation are consequently inevitable.…”

“…Usually, the expanded flap is not large enough to drape the entire framework, so skin grafts and postauricular facial flap elevation are consequently inevitable. Xing et al and Li et al described their novel strategies to avoid skin grafts; however, a surgical procedure with ≥3 stages was still required (19,26).…”

“…We didn't select the initial incision of tissue expander implantation to remove the expander, which was described by a number of researchers who practice tissue expansion (25)(26)(27)(28). During the second stage, a Y-shaped lobule incision on remanent ear was made to reach the expander and remove the capsule beside it.…”

Clinical efficacy of modified total auricular reconstruction technique by using reformative inflation method and remnant ear without skin grafting

“…Total auricular reconstruction remains the primary treatment for microtia (5), and is a great challenge for plastic surgeons globally. The skin envelope and the three-dimensional framework are two eternal themes of auricular reconstruction (6). In addition to the pursuit of a more delicate and lifelike 3D ear framework, many surgeons are still working on tissue coverage techniques to achieve satisfying results with few complications.…”