Does postauricular fascial flap reduce suture complications in otoplasty?

Abstract

Numerous suture techniques and covering flaps have been described to minimize complications related to sutures in otoplasty. The split postauricular fascial flap is one of such techniques, and it has been used to pad otoplasty suture. The aim of this study was to evaluate complications related to nonabsorbable cartilage sutures in otoplasty, using a variation of the split postauricular fascial flap. In this retrospective case series, we analyzed otoplasty patients in whom simplified split postauricular fascial flap was utilized. A postauricular skin ellipse was de-epithelialized (preserving dermis) and a longitudinally split in half. Flaps were dissected, and they were positioned on the cartilage to promote additional soft tissue coverage to the sutures. The lateral flap covered conchoscaphal sutures while the medial flap covered the conchomastoid sutures. Both the flaps were not sutured to cartilage. Early and late postoperative complications were evaluated. A total of 142 patients were included. Twenty-four (16.9%) patients developed late complications: 13 (9.1%) patients had palpable and visible sutures, nine (6.3%) had suture extrusion and two (1.4%) had hypertrophic scars. In this case series, the simplified split postauricular flap did not prevent or reduce late complications related to suture extrusion in otoplasty. It is possible that suturing the entire length of the flaps may play a role in our results. So, anchoring the flap and possibly tightening it a little may be an important technical step to prevent extrusion of sutures whenever the postauricular flap is used.

Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity

“…Postauricular adipofascial flaps have been described to provide additional soft tissue coverage of Furnas and Mustardé sutures. 1 , 4 , 14 Horlock et al 16 and Irkoren et al 17 did not report any suture extrusion events following the use of postauricular adipofascial flaps in 51 and 100 cases, respectively. However, other studies have tried to replicate these findings, with suture extrusion and recurrence rates of 2.64% 14 and 4.8%, 18 respectively.…”

“…Prominent ear is the most frequent congenital external ear deformity, affecting roughly 5% of the general population. 1 – 3 Although the deformity presents with no functional problems, the condition often has significant psychological and social impacts on the patient, especially in children. 4 – 6 As such, otoplasty has become one of the most common aesthetic operations in children and adolescents.…”

Correction of Prominent Ears: Postauricular Muscle Relocation and Fibrofatty Tissue Excision

“…Our complications including hematoma (1.25% of the ears), perichondritis (1.25% of the patients), and hypertrophic scars (2.5% of the ears) were at a quite acceptable rate compared with other cartilage-sparing techniques. 11,12,22,23 We attribute this to our meticulous dissection and bleeding control. We observed no wound infection or skin necrosis in any of our cases.…”

“…Although we did not use a posterior facial flap technique, we had a similar rate of suture extrusion complications (2.5% of the ears) compared to the other studies using facial flaps, which reported complication rates ranging from 0% to 7.3%. 11,22,23 We presume that the vascularization of skin flap and flap thickness were not changed since we undermined the postauricular skin flap in the subdermal plane by cold dissection. This preservation as well as the suture materials we used were effective in our success.…”