A two-stage inversion technique for total auricular reconstruction: case report and literature review

Abstract

BackgroundThe reconstruction of a total amputated auricle is aesthetically demanding for otorhinolaryngology surgeons. Although various reattachment methods have been introduced since 1898, only a few have achieved satisfactory aesthetic outcomes. This study aimed to present a successful case of auricular reconstruction using a two-stage inversion technique.Case presentationThe patient’s left ear was extensively lacerated in a violent event 3 h before admission. The first-stage surgery was performed within 6 h of ischemic time. The amputated segment was prepared and trimmed carefully, and the anterior aspect of the avulsed auricle was directly sutured. The posterior skin of the ear was separated from the cartilage to close the wound. Then, using an inversion maneuver, the cartilage was pushed into a postauricular underlying muscle bed. In the second-stage surgery 27 days after the first procedure, the auricle was released and the normal ear structure was restored using full-thickness skin grafting. During a follow-up of more than 9 years, the patient showed satisfactory postoperative results in terms of cosmetic and functional outcomes of the reattached auricle. The size of his left ear was about 90% of the size of his right ear.ConclusionsThe reconstruction of a total amputated auricle is challenging. The key to surgery lies in the sufficient preservation of the meticulous shape of the cartilage. The microsurgical anastomosis is a good choice only in selected cases. It is believed that the two-stage inversion technique can be a simple alternative to reconstruct the auricle in most situations when it is lacerated and contaminated.

Management der Ohrmuschelteilamputationen

“…Es existiert eine Vielzahl von meist mehrzeitigen Operationstechniken und Modifikationen, die in der Literatur beschrieben werden: direkte Annaht, mikrovaskuläre Anastomose, Pocket-Methode, sekundäre Rekonstruktion mit autologem Rippenknorpel usw. [6,13,14,15].…”

Mechanisms of Soft Tissue Injury

“…2,7,9 If the cartilage is denuded or if there is complete avulsion, coverage with a postauricular pocket is indicated. 7,8,10,11 The external auditory canal should be inspected for injuries that would require bolsters to prevent stenosis. 7…”

A Case Report: The Staged Retro Auricular Flaps for Auricle Reconstruction After Traumatic Amputations

“…Severe auricular trauma, especially complete amputations, is a rare injury 1,2 . In addition, the severed ear is a major challenge for plastic surgeons 3 .…”

“…Ear repair is difficult because of the intricate structure of the ear and the scarcity of local tissue. The unique and intricate anatomical nature of , Yugos Juli Fitra a the auricle, with its fine skin covering, thin and elastic cartilage, and constrained blood supply caused by the tiny size of the capillaries responsible for its perfusion, is mostly to blame for the difficulties of reconstitution 2,3 .…”

“…Since 1898, several reattachment techniques have been developed, but only a select few have produced acceptable cosmetic results 2 . The purpose of this study was to present a successful example of stepwise retro-auricular flap restoration of the auricle.…”