Application of Sandwich Shape Double Bilobed Flap in Auricular Defects

Abstract

BackgroundReconstruction of auricular defects is a challenging surgical procedure because of its complex 3-dimensional structure. Various surgical techniques have been used for the reconstruction of the auricle. However, most of these techniques are not applicable to the reconstruction of marginal and central defects, and the texture and color harmony of the reconstructed parts were not evaluated in detail. Thus, the aim of this study is to present a novel technique, sandwich shape double bilobed flap, which can be used for correcting, both, central and marginal defects of the auricle and to evaluate esthetic outcomes with objective and quantitative parameters.MethodsIn this study, 24 patients with partial thickness auricular defects were treated with a bilobed flap, and excess tissue in the postauricular sulcus region was transferred to the defective region on the anterior surface. Color compatibility between the flap and surrounding tissues, patient's satisfaction on the final shape and auricular symmetry, as well as anterior scar formation on the auricle were evaluated.ResultsThe color, texture, and thickness of the flap matched well with the adjacent auricular tissue and there was no perceptible color difference. The original size, projection, and subunits of auricles were maintained. All patients were mostly very satisfied with surgical outcomes (mean satisfaction score, 4.75 ± 0.4). There was only inconspicuous scar on the visible anterior surface of the auricle (mean patients' scores, 2.22 ± 0.3; mean observers' scores, 2.6 ± 0.4).ConclusionsThe sandwich shape double bilobed flap technique preserved size and subunits of the auricle. Additionally, this procedure also resulted in inconspicuous scarring as well as similar color, texture, and thickness of the flap with the surrounding tissue, thereby achieving satisfying esthetic outcomes.

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

“…After Song et al 22 detailed the specific anatomy of the SAA, postauricular tissue has become one of the cornerstone flaps in the repair of auricular defects. 13,20,21 The superior and inferior pedicle retroauricular island flap was used to reconstruct marginal and nonmarginal cutaneous defects of the auricle in a large patient series, as reported by Cordova et al, 20,21 but was not used for full thickness defects. Selcuk et al 10 reconstructed full-thickness helical defects of the upper or middle one-third of the auricle using an SAA-based postauricular chondrocutaneous flap.…”

“…The abundance and laxity of soft tissue and concha cartilage in postauricular areas present significant potential donor areas for auricular reconstruction. After Song et al 22 detailed the specific anatomy of the SAA, postauricular tissue has become one of the cornerstone flaps in the repair of auricular defects 13,20,21 . The superior and inferior pedicle retroauricular island flap was used to reconstruct marginal and nonmarginal cutaneous defects of the auricle in a large patient series, as reported by Cordova et al, 20,21 but was not used for full thickness defects.…”

“…Reconstruction of full-thickness helical defects presents considerable challenges. 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.…”

“…Reconstruction of full-thickness helical defects presents considerable challenges 1,4,6,7,10,12–14,16–18 . 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 4,6–8,10–13,17,19 …”

“…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.…”