Burned Ear Reconstruction Using the Combination of an Expanded Postauricular Scar Skin Flap and a Postauricular Fascial Flap

Guo, Peipei; Pan, Bo; Jiang, Haiyue; Yang, Qinghua; Lin, Lin

doi:10.1055/s-0040-1719101

Cited by 5 publications

(8 citation statements)

References 16 publications

(20 reference statements)

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“…Tissue expansion is a good method to overcome the problems mentioned above. 9,14,17 Traditional tissue expansion method was usually applied to enlarge the area of the postauricular skin and make it thinner. However, for patients with poorly elastic skin, especially combined with a relatively large contralateral ear, they always required more skin coverage and long-term expansion.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] The frequency of saline injection is also difficult to control, as too rapid expansion leads to problems in the blood supply of expanded flap, while too slow causes an overly thick capsule and waste of time. 9,13 Furthermore, research showed that complications such as necrosis of the expanded flap and exposure of the tissue expander often occurred in the late expansion period. And in patients with postauricular scars, flap necrosis would be more common, especially in the late period of expansion, and blood supply and skin tension should be carefully monitored.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue expansion is a good option to expand the insufficient postauricular skin flap. 9 Neumann, Park, and Zhang have made landmark contributions by developing tissue expansion methods, which obtained satisfied results these years. [10][11][12] However, patients with tight and insufficient mastoid skin are more likely to suffer from the exposure of the expanders and the ischemia to the expanded flap.…”

Section: Introductionmentioning

confidence: 98%

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A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin

et al. 2023

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Objective For microtia patients with excessively insufficient postauricular skin, it is difficult to obtain a satisfied outcome with existing strategies. In this study, we developed a modified tissue expander method for auricular reconstruction. Methods The modified tissue expander method divided into 4 stages. In the first stage, a 30 ml or 50 ml kidney-shaped tissue expander was implanted in the mastoid region. A short time expansion (average 33.5 days) was conducted subsequently. In the second stage, the expander was removed and a modified cartilage framework without tragus was inserted through the same incision. A crescent-shaped cartilage pad was inserted into the incision of cartilage-harvest site at the same time. In the third stage, the reconstructed ear was elevated. Lobule rotation and remanent modification were performed in the fourth stage. The patients were followed up between half a year and 10 years. The outcomes of the reconstructed ears were scored with evaluation criteria. Results From January 2010 to December 2019, a total of 45 microtia patients with excessively insufficient postauricular skin were performed the modified tissue expander method. Fourty-two patients showed satisfied outcomes. Complications such as hyperpigmentation in the skin graft area (3, 6.7%), scar hyperplasia (3, 6.7%) and folliculitis (1, 2.2%) were found. There were no complications related to the tissue expander. Conclusion The modified tissue expander method is an effective and safe technique for auricular reconstruction in patients having excessively insufficient postauricular skin, with satisfying medium-term results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin

et al. 2023

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“…In most cases, a W-or V-shaped posterior lobule incision on the remnant ear is an effective way to increase the skin surface area for framework coverage (5-7). However, in cases of tiny remnant ear or anotia, skin that was damaged by previous operation or trauma, poor skin mobility, low position of the hairline, or severe hemifacial microsomia, a tissue expansion procedure was necessary to provide additional hair-free skin to cover the framework (20)(21)(22). Tissue expansion was first applied in auricular reconstruction by Neumann in 1957 (10).…”

Section: Discussionmentioning

confidence: 99%

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

Ou¹,

Cao²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Total auricular reconstruction is a challenge for plastic surgeons. Expanded flap method and Nagata's method with autologous costal cartilage are two leading techniques for ear reconstruction. And a two-stage strategy of expanded flap method received attention. In the present study, we report the incision and flap design of this strategy.Methods: In the first stage, an 80 mL kidney-shaped expander was inserted in the mastoid region with the larger pole superiorly. The expander pocket was dissected subcutaneously in the scalp area and subfascially in the lower third region. In the second stage, the expander was removed from a Y-shaped lobule incision on the remanent ear. Then the remnant ear was separated into three flaps: the posterior skin flap, anterior skin flap, and lobule flap. When the framework was fabricated, the base frame and the underlying pad, which enhanced the projection, were fixed together as a whole to provide a more prominent appearance. The framework was totally wrapped into the expanded single flap without free skin grafting. Lobule transposition and tragus construction were performed simultaneously instead of a third-stage surgery. The recipient bed of rotated lobule was resected only to the epidermal layer and the subcutaneous layer was preserved to avoid central necrosis.Results: A total of 21 patients received this strategy to reconstruct ear. With 3 months to 1.5 years of follow-up, 19 patients (90.5%) were satisfied with the reconstructed ears. 3 patients (14.3%) required further modification of reconstructed ear. No serious complications occurred during the procedures.Conclusions: With a Y-shaped incision, three-flap design of remanent ear and lobule rotation to an epidermal-removal area, tissue expander removal and modification of remanent ear can be performed effectively to avoid necrosis and an extra operation.

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“…With worldwide efforts of surgeons, expanded skin flap method has been modified and is now widely used to overcome skin inefficiency. [9][10][11][12][13][14][17][18][19][20][21][22][23] Complications came after the increasing use of expansion technique. Chen reported 24 cases of partial necrosis of the expanding postauricular flap, with an incidence of 2.9% of necrosis, which is similar to the current study (3.3%).…”

Section: Discussionmentioning

confidence: 99%

Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

Cao

Zhang

2021

Ear Nose Throat J

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Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

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Burned Ear Reconstruction Using the Combination of an Expanded Postauricular Scar Skin Flap and a Postauricular Fascial Flap

Cited by 5 publications

References 16 publications

A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin

A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin

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

Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

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