The Postauricular Fascial Flap as an Adjunct to Mustardé and Furnas Type Otoplasty

Abstract

Anterior riberation methods of otoplasty have been criticized because of the risk of anterior hematoma that can cause anterior skin necrosis, scarring, and even cartilage destruction caused by infection. As a result, cartilage-sparing otoplasty such as the Mustardé and Furnas types has been increasingly popular. However, postauricular suture extrusion may result, and recurrence rates of up to 25 percent have been recorded. In this study, cartilage-sparing otoplasty is refined by the addition of a postauricular fascial flap to reduce suture extrusion and recurrence rates. Fifty-one patients underwent otoplasty (45 bilateral, six unilateral). This technique involves the elevation of a fascial flap from the postauricular region. A new antihelical fold is then created by Mustardé sutures, and the conchal bowl is rotated by Furnas-type concha-mastoid sutures. The fascial flap is then advanced to cover the sutures with a supplementary vascularized layer to prevent suture extrusion. In addition, the advancement of the flap acts as a postauricular support to prevent recurrence. A natural-looking antihelical fold and helical rim is created by this technique. There were no hematomas. There was recurrence in eight ears (8 percent) in six patients. Two patients requested further surgery. No patients developed suture extrusion or granuloma. This is a simple and intrinsically safe procedure and does not cause irreparable complications such as anterior scarring or skin necrosis. The postauricular fascial flap seems to prevent suture extrusion. It may also help to reduce recurrence rates to acceptable levels.

Otoplasty: The case for skin incision by higher volume operators

“…3e6 Instead, cartilage-sparing techniques using Mustardé and Furnas type sutures have been shown to yield significantly more favourable outcomes. 9 This is in keeping with the experience from our unit. We have previously published our results 3,4 comparing outcomes from different otoplasty techniques, and shown that posterior suturing with posterior fascial otoplasty, as described by Horlock, Misra and Gault in 2001, are consistently superior to anterior scoring or posterior suturing alone, both in terms of reduced complication and clinical recurrence rates and improved patient and parent satisfaction.…”

“…Skin excision during otoplasty was advocated by Horlock in his original 2001 paper 9 and dates back to the publications by Mustardé and Furnas in 1978. 7,8 Though it was never specifically explained, it is reasonable to assume that the rationale behind skin excision is (1) to address any relative skin redundancy resulting from setting back the ear and (2) to reduce the chances of recurrence of the ear prominence.…”

“…All procedures were performed under general anaesthetic using Horlock's, posterior, cartilage-sparing technique, 9 involving (1) access through the posterior skin of the auricle either through a curvilinear incision or following skin excision (elliptical or dumbbell-shaped depending on technique) (2) undermining the postauricular skin to the helical rim (3) raising a perichondrial fascial flap off the helical rim and exposing the cartilage (4) recreation of underdeveloped antihelical folds using Mustardé sutures (4e0 Ethibond) (5) setback of the concha (if indicated) using Furnas-type choncho-mastoidal sutures (4e0 Ethibond) and (6) interposition of the fascial flap between the suture line and skin flaps. Postoperatively, patients wore a head bandage for a week, at which point they were reviewed at the dressings clinic and were followed up by the surgeon at the outpatients department for assessment of the final result a few months after surgery.…”

“…3e6 Among cartilage-sparing techniques, posterior suturing for antihelical fold recreation and conchal bowl setback, as described in 1978 by Mustardé 7 and Furnas 8 respectively, are the commonest. Horlock's proposed interposition of an extra fascial layer between the sutures and skin flaps, designed to reduce suture extrusion rates, 9 was published in 2001 and is a popular modification of the original Mustardé and Furnas approach.…”

Fascioperichondrial Flap with a Proximal Base Combined with Prominent Ear Surgery

“…Post-auricular proximal-based fascial flap, illustrated by Horlock et al (24), combined with posterior suturing has been demonstrated to be the method with the lowest recurrence and least complication rates by Schaverien et al (25). In a follow-up period of 3.9 years (range: 1.5-7.8), the clinical recurrence rate was 4.5%.…”