Total auricular reconstruction using extended retroauricular flap and tissue expansion

Abstract

Objective To investigate the modification of the classic techniques of total auricle reconstruction with skin expansion, and its clinical application. Methods We performed three-dimensional measurement of the normal auricle and the expanded flap on 150 microtia patients. According to the data, we carried out total auricle reconstruction using extended postauricle expanded flap techniques for 82 patients of the group. Firstly, a 50 ml kidney-shaped expander was inserted subcutaneously in the mastoid region. Approximately 65 ml saline was injected in about 30 days, and expansion was kept without injection for another 30 days. In the second stage, we removed the expander and dissected the scalp 4-5 cm around the expanded skin, to make a composite flap consisted of expanded skin and extend scalp. Then we used the flap to encapsulate the three-dimensional rib cartilage framework to accomplish total auricle reconstruction. Results The blood supply and venous drainage of the flap was good. No obvious postoperative flap swelling was observed. Only 2 cases of helix skin necrosis happened in 48 hours after operation. Small area of skin defect was treated by debridement and suture, while larger area of skin defect was repaired with postauricular fascia flap and free skin graft. Postoperative follow-up period was 4-15 months, about 6.7 months in average. Bilateral ear size and position were similar with clear structures and shapes. Helix seemed more slim, auriculocephalic sulcus was obvious, auriculocephalic angle was similar to the other side. There was no color abberration between the front and back side of reconstructed ear. Scars of retroauricular hairline incision and costal cartilage harvesting incision were not obvious. Conclusions The novel surgical techniques is reasonable and simple without fascia flap or skin graft, which is worthy of application by more plastic surgeons. Key words: Microtia; Skin soft tissue expansion; Auricle reconstruction