Treatment of Folliculitis on the Expanded Postauricular Skin Flap by Topical Iodine Tincture.

Abstract

Sir: Expanded flap method for microtia reconstruction is widely used in clinical practice, including expanded 1-flap method and expanded 2-flap method.1–3 However, the color, texture, and thickness of the expanded flap can influence the appearance of the reconstructed ear markedly. From September 2007 to January 2015, 1956 patients with microtia or anotia were treated in our department in which 391 patients were treated by expanded one-flap method, while the other 1565 patients were treated by expanded two-flap method. Complications caused by the postauricular tissue expander are common to see, such as hematoma, infection, expander exposure, and expander extravasation. Moreover, folliculitis often appears on the surface of the expanded skin flap (Fig. 1), especially in adolescents and those who have suffered folliculitis on the face. Our department treated 109 patients who had folliculitis with 2% Iodine Tincture since September 2008. We usually paint a radius of 0.6–0.8 cm with tincture of iodine. If the folliculitis has not formed abscess, the erythema would disappear within 1–2 days, or else the abscess gradually vanishes in 3–5 days.Fig. 1: Multiple folliculitis occurred 2.5 months after expander implantation.A 2% Iodine Tincture is a broad-spectrum, high-performance antiseptic, which can oxidize active genes in a pathogen’s cytoplasmic proteins and interact with amino in proteins, leading to denaturation of the bacteria protein; 2% Iodine Tincture has the ability to kill the vegetative cells and spore rapidly. The bactericidal activity is proportional to the concentration of it. Iodine Tincture is not only active against Gram-positive bacteria, such as Staphylococcus aureus, but also inhibitory for anaerobes and fungi. When local abscess forms in folliculitis patients, it is mainly treated by incision and drainage or rupturing the surface of the abscess.4 While the expanded skin flaps are generally thin, inappropriate procedure may result in the expander exposure. Owing to the expanded skin flap lying over the costal cartilages framework with no blood supply, local breakdown of the flap may lead to cartilage exposure. Twenty samples were collected when the folliculitis formed abscess. The positive rate of bacteria culture was 20% (4/20), 6 pathogenic bacteria were cultivated, 4 of 6 Gram-positive bacteria (67%) were S. aureus. The effect of using Iodine Tincture locally is direct and reliable. When we painted folliculitis with Iodine Tincture, trace amounts of ethanol volatilize immediately, iodide ion deposit and osmosis to stroma layer. With 2% Iodine Tincture, the hyphae were damaged rapidly, the lesion contracted gradually, necrosis of tissue was broken off, and collagen fibers were repaired to scarring or returned to certain transparency. Eventually local inflammation could be limited and the folliculitis cured with a favorable outcome (Fig. 2).Fig. 2: The folliculitis was cured by Iodine Tincture, 75% alcohol, and consequent iodophor.