Reconstruction of a near total ear amputation with a neurosensorial radial forearm free flap prelaminated with porous polyethylene implant and delay procedure

Abstract

When an auricular defect is caused by high-energy trauma that causes damage to the surrounding tissues, the patient may be not a candidate for reconstruction with local flaps and free tissue transfer may be necessary. Here we present a case of total auricular reconstruction in a 27 year-old man who had total loss of the left ear and traumatized temporal skin and fascia. A radial forearm flap prelaminated by a porous polyethylene implant was employed. A "printed" ear made of silicone, based on the patient's CT-scan of the contralateral ear, was used for intraoperative molding of the future reconstruction. Prolonged prelamination time and surgical delay (three months) were performed to reduce edema, distortion and loss of definition of the framework after revascularization. After subsequent integration and neovascularization of the added tissue, the prelaminated flap was transferred. Flap reinnervation was also performed by direct coaption of the great auricular nerve to the lateral antebrachial cutaneous nerve. The flap fully survived and there were no complications in the early postoperative period. Between 3 and 6 months, the patient returned to normal ranges in terms of warmth and cold, and recovered the discriminative facial sensibility. After one year the auricular reconstruction was intact and satisfactory aesthetic results were achieved. This method may offer a satisfactory solution for a difficult problem and may be considered for acquired total ear defects.

The periosteal‐cutaneous chimeric medial femoral condyle free flap for subtotal ear reconstruction: A case report

“…In cases where the original cartilage has been compromised by infections, the avascular cartilage graft should be relatively contraindicated. Alloplastic materials provide a F I G U R E 3 Flap insetting in the auricular region (a), the anterior part of the construct was covered by a thinned dermal flap (b), while the chimeric skin paddle assured the retro-auricular skin coverage (c) F I G U R E 4 Postoperative results at 6 months preformed framework, decreasing the surgical skills required and the operative time, but are known for some complications, particularly encapsulation, extrusion, migration and infection (Horta et al, 2018).…”

“…Free flaps, notably the radial forearm free flap and the temporoparietal fascial free flap, can be used either to cover directly the grafted cartilage constructs or the implant, or in a prelaminated/prefabricated fashion requiring a multistaged procedure (Horta et al, 2018).…”

“…In cases where the original cartilage has been compromised by infections, the avascular cartilage graft should be relatively contraindicated. Alloplastic materials provide a preformed framework, decreasing the surgical skills required and the operative time, but are known for some complications, particularly encapsulation, extrusion, migration and infection (Horta et al, 2018). As well, the soft tissue coverage strategies are debated.…”

“…Microsurgical free tissue transfers for ear reconstruction have been proposed in literature when costal grafts were contraindicated. However, to date, flaps have been prelaminated with alloplastic implants to support the ear shape (Horta et al, 2018).…”

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

“…Mladick introduced the “pocket principle” in 1971 [ 3 ] to improve the direct reattachment method; several variations of this technique have been described ever since. Their common characteristic is that the skin of the amputated part is removed by dermabrasion and then the avulsed cartilage is buried in a subcutaneous pocket, in either the postauricular, [ 4 , 5 ] abdominal, [ 6 , 7 ] supraclavicular, [ 8 ] cervical, [ 9 ] or forearm region [ 10 , 11 ]. A second procedure to remove and re-epithelialize the buried pinna is required.…”