Creating a re-expanded prefabricated island flap constructed with an anastomosed vascular pedicle for burned ear reconstruction: a case report

Abstract

The combined use of various flap techniques has rapidly improved the reconstruction quality of auricle defects that are complicated by a scarcity of periauricular skin after severe burns. Nevertheless, there is still no preferable method when the optimal alternative skin to cover the auricular framework is unavailable and the periauricular vascular network is devastated. Copious scars were observed in the periauricular region, neck, forearm, and supraclavicular region of a 19-year-old man. He had been burned by high-voltage electricity and exhibited a right auricular defect. We innovatively created a prefabricated expanded island flap constructed with an anastomosed vascular pedicle buried in the anterior thoracic chest, followed by flap transfer, tissue re-expansion, and sculpted autologous costal cartilage implantation. The remnant ear was successfully reconstructed in a three-stage surgical procedure. All the flaps survived well without any complications. The reconstructed right ear had a natural shape and a clear structure without apparent displacement and deformation during follow-up. The patient was satisfied with the final appearance, and his neck mobility markedly improved. Advantages and disadvantages were discussed. This procedure explored a novel solution to construct an auricular framework covering for patients who do not have high-quality donor skin and lack anastomotic vessels in the recipient area.