Cartilage Skeleton Research Articles

A Review of campomelic dysplasia syndrome

Campomelic dysplasia (CD) is a rare autosomal dominant genetic disorder and severe skeletal dysplasia. It is characterized by a variable relationship between skeletal and extra-skeletal abnormalities: congenital tightness and long bone arches, pelvic and chest abnormalities, eleven pairs of ribs instead of the usual twelve, facial deformities, cracks and sexual ambiguity. The appearance of pelvic joints, horseshoe inversion, pulmonary hypoplasia, abnormalities of the neck and cervical spine, as well as heart and kidney abnormalities also indicate this syndrome. Other findings of the CD include sexual reversals, in which males have chromosomes, but in some individuals have female genitalia and reproductive systems. The CD is caused by a de novo mutation in the SRY box containing gene 9 (SOX9), which is the main regulator of the development of the cartilage skeleton. It plays an important role in the selection and differentiation of mesenic cells of the chondrocyte lineage of all components of the cartilage skeleton. Most affected individuals have recognizable mutations. It has been reported that heterozigosity involves mutations involving missene, meaningless mutations, deletions in the coding area, and mutations that sometimes interfere with the reorganity of chromosomes in the SOX9 regulatory area. Loss or loss of control over this regulatory area around SOX9 may explain the level of craniophaasial defects described in CD syndrome. We outline the clinical picture, treatment and spectrum of mutations involved in CD syndrome. However, more research is needed to determine the effects of SOX9 on the binding of other genes that function well or are unknown on cartilage.

Do the upper lateral nasal cartilages exist? The concept of septolateral cartilages

BackgroundIn the cartilaginous nose, classical surgical anatomy describes 2 triangular upper lateral cartilages (ULCs) framing the lateral sides of the mid-third of the nasal pyramid, which articulate with to the superior edge of the quadrangular cartilage (QC) of the nasal septum. This anatomic arrangement in 3 distinct cartilage parts is, however, controversial. ObjectiveThe present study aimed to describe the articulation between the ULCs and the QC, avoiding dissection artefacts. Materials and methodsSix nasal pyramids were taken in monobloc from fresh cadavers and imaged on micro-MRI with 0.4mm slice thickness. Images were interpreted jointly by 2 head and neck surgeons and a radiologist. ResultsThe cartilage skeleton supporting the mid-third of the nasal dorsum in all specimens presented as 2 septal plates backing onto the midline and curving on either side to form a continuous dome under the inferior aspect of the piriform aperture. ConclusionLike the alar cartilages framing the tip of the nose, there are two continuous septolateral cartilages (SLCs) framing the mid-third of the nasal pyramid, likewise showing 2 cruras, medial and lateral, joined in a dome. The SLCs (also known as triangular cartilages) thus cannot be separated as 2 individual anatomic structures. These findings are in line with the shared embryological origin of all the elements composing the fibrocartilaginous nose in evo-devo theory.

Making cartilage throughout life

Development The skeletons of newborn mammals are soft and pliable because they are composed primarily of cartilage. During growth to adulthood, most cartilage is replaced by bone. The remaining cartilage, such as that found in the joints, does not readily regenerate, so joints deteriorate with age. By contrast, elasmobranch fish make cartilage throughout their lives. Marconi et al. studied the cartilaginous fish Leucoraja erinacea , or little skate, from embryo to adult and observed that progenitor cells that surround the cartilage skeleton are also present in the adult. These cells are induced to transform into chondrocytes after injury. Understanding cartilage repair in skates may offer inspiration for research into human joint repair. eLife 9 , e53414 (2020).

Repair of the Protruding Lobule.

In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.

Structure and mechanical implications of the pectoral fin skeleton in the Longnose Skate (Chondrichthyes, Batoidea).

Batoid fishes have very light cartilaginous skeletons that facilitate their elegant swimming by applying their enlarged wing-like pectoral fins. Previous studies have shown structural features and mechanical properties of the mineralized cartilage skeleton in various batoid fishes. However, the details of the pectoral fin structure at different length scales, as well as the relationship between the mechanical properties and structural design remains unknown. The present work illustrates the hierarchical structure of the pectoral fin of the Longnose Skate (a representative batoid fish) and verifies the materials configuration and structural design increases the stiffness of fin skeleton without a loss in flexibility. These results have implications for the design of strong but flexible materials and bio-inspired autonomous underwater vehicles (AUVs).

Histology and Immunohistochemistry of the Cardiac Ventricular Structure in the Green Turtle(Chelonia mydas)

This study describes the implications of cardiac ventricular microscopy in Chelonia mydas relating to its ability to dive. For this work, 11 specimens of the marine turtle species C.mydas found dead on the coast of Rio Grande do Norte (Northeast Brazil) were used. After necropsy, fragments of the cardiac ventricular wall were fixed in 10% buffered formaldehyde solution for 24h and then subjected to routine processing for light and scanning electron microscopy (SEM). The ventricle in this species is formed by the epicardium, myocardium and endocardium. The subepicardial layer consists of highly vascularised connective tissue that emits septa to reinforce the myocardium surface. There is an abundant and diffuse subepicardial nerve plexus shown by immunostaining technique. The thickness of the spongy myocardium and the nature of its trabeculae varied between the heart chambers. The endocardium shows no characteristic elements of the heart conduction system. The valves have a hyaline cartilage skeleton, coated by dense irregular connective tissues characterised by elastic fibres. These findings in the green turtle ventricular microscopy are related to hypoxia resistance during diving.

Anatomic Analysis of the Conchal Bowl Cartilage

The conchal bowl is a portion of auricular cartilage commonly used as an autologous graft for various maxillofacial procedures. Few studies have attempted to describe the anatomy of this region in detail, particularly in relation to the curvature of the conchal bowl. The present study has provided detailed information about the anatomy of the auricular cartilage in the conchal bowl region that could assist in the surgical design of graft harvesting. A total of 35 pairs of cadaver ears without gross deformity (15 male, 20 female; aged 39 to 99 years) were dissected to completely expose the cartilage skeleton. Each cartilage was stabilized, and the conchal bowl was mapped. The starting reference point was defined as the intersection of the lateral border of the antihelix and the superiormost aspect of the inferior crux. A prefabricated grid was then used to imprint a 4 × 5 matrix of pinpoint ink spots on the surface of each cartilage, with 6-mm increments between each spot. The grid's y and x axes were then aligned with the landmarks above. Next, a MicroScribe 3-dimensional digitizer (ghost3d.com) was used to capture the 3-dimensional coordinates for each point on the ear's surface and the coordinates were transferred into an Excel spreadsheet. After digitization, a Boley gauge was used to measure the thickness of the cartilage at each premarked spot. The gathered data points and measurements were examined to describe our parameters of interest (ie, depth, thickness, and curvature). The average maximum conchal bowl depth was 10.5 ± 3.0 mm in the female ears and 10.7 ± 2.5 mm in the male ears. In general, the conchal bowl depth at each point did not differ significantly between the males and females. The mean cartilage thickness ranged from 0.77 to 1.79 mm (mean 1.15 ± 0.26) in the females and 0.95 to 1.45 mm (mean 1.25 ± 0.23) in the males. Both genders showed an increase in the conchal bowl depth from inferiorly to superiorly and from posteriorly to anteriorly. The cartilage thickness also increased from posteriorly to anteriorly; however, the exact shape is complex. A detailed understanding of the facial anatomy is important in the practice of facial surgery. The results we have presented will provide surgeons with information on the overall dimensions, thickness, and curvature of the conchal bowl that could allow more advantageous donor site selection.

Comparison of the Structure and Composition of the Branchial Filters in Suspension Feeding Elasmobranchs

The four, evolutionarily independent, lineages of suspension feeding elasmobranchs have two types of branchial filters. The first is a robust, flattened filter pad akin to a colander (e.g., whale sharks, mantas and devil rays) while the second more closely resembles the comb-like gill raker structure found in bony fishes (e.g., basking and megamouth sharks). The structure and the presence of mucus on the filter elements will determine the mechanical function of the filter and subsequent particle transport. Using histology and scanning electron microscopy, we investigated the anatomy of the branchial filters in 12 of the 14 species of Chondrichthyian filter-feeding fishes. We hypothesized that mucus producing cells would be abundant along the filter epithelium and perform as a sticky mechanism to retain and transport particles; however, we found that only three species had mucus producing goblet cells. Two of these (Mobula kuhlii and Mobula tarapacana) also had branchial cilia, indicating sticky retention and transport. The remaining filter-feeding elasmobranchs did not have a sticky surface along the filter for particles to collect and instead must employ alternative mechanisms of filtration (e.g., direct sieving, inertial impaction or cross-flow). With the exception of basking sharks, the branchial filter is composed of a hyaline cartilage skeleton surrounded by a layer of highly organized connective tissue that may function as a support. Megamouth sharks and most of the mobulid rays have denticles along the surface of the filter, presumably to protect against damage from large particle impactions. Basking sharks have branchial filters that lack a cartilaginous core; instead they are composed entirely of smooth keratin.

Korrektur von Ohrmuscheldeformitäten infolge Ohranlegeplastik

Failed otoplasty can result in deformities which are more annoying than the preoperative state of prominent ears, especially if aggressive cutting or scoring techniques are used. This article describes how such deformities can be corrected successfully. Ugly creases and edges can be corrected through readapting the cartilage edges followed by revision otoplasty using suture techniques. If cartilage defects are present, porous polyethylene implants can restore an aesthetic form of the auricle. The author has successfully treated 16 severe ear deformities after failed otoplasty in the last 3 years with the procedures described. The author recommends reconstructing the cartilaginous skeleton and redoing otoplasty with suture techniques rather than merely camouflaging creases with fascia or preserved materials. Porous polyethylene implants can successfully be used instead of autogenous cartilage to reconstruct a missing ear cartilage skeleton.

A Histological Comparison of the Original and Regenerated Tail in the Green Anole, Anolis carolinensis

This study provides a histological comparison of the mature regenerated and original tail of the lizard Anolis carolinensis. These data will provide a framework for future studies of this emerging model organism whose genome was recently published. This study demonstrated that the cartilage skeleton of the regenerated tail enclosed a spinal cord with an ependymal core, but there was no evidence that dorsal root ganglia or peripheral nerves are regenerated. The cartilage tube contained foramina that allowed the vasculature to cross, but was otherwise a rigid structure. The original tail has muscle groups arranged in quadrants in a regular pattern that attach to the vertebral column. The regenerated tail has irregular muscle bundles of variable number that form unusual attachments to each other and to the cartilage tube. Furthermore, the data show that there was increased connective tissue within the muscle bundles. Implications for functionality of the regenerated tail and for future biomechanical studies are discussed.

Revision Otoplasty

To describe how severe ear deformities after otoplasty can be corrected. The correction of creases is possible through readaptation of the cartilage edges followed by revision otoplasty using suture techniques in the reconstructed cartilage. In the case of defect formation or extreme thinning of the cartilage, an appealing auricular shape is achieved by the use of porous polyethylene implants. We have treated 12 severe ear deformities in the past 2 years with the procedures described herein. In 11 cases, there were no complications, nor was it necessary to make further corrections for cosmetic reasons. Reconstructing the cartilaginous skeleton and redoing otoplasty is a recommendable procedure with a longer lasting effect than just covering creases with fascia or preserved materials. In the case of a missing ear cartilage skeleton, the use of porous polyethylene implants instead of autogenous cartilage should be considered for reconstruction.

Bremsstrahlung parameters of praseodymium-142 in different human tissues: a dosimetric perspective for 142Pr radionuclide therapy

Praseodymium-142 [T 1/2=19.12h, [Formula: see text]=2.162MeV (96.3%), Eγ=1575keV (3.7%)] is one of the (141)Pr radioisotopes. Many studies have been attempted to assess the significance of usage (142)Pr in radionuclide therapy. In many studies, the dosimetric parameters of (142)Pr sources were calculated by modeling (142)Pr sources in the water phantom and scoring the energy deposited around it. However, the medical dosimetry calculations in water phantom consider Bremsstrahlung production, raising the question: "How important is to simulate human tissues instead of using water phantom?" This study answers these questions by estimation of (142)Pr Bremsstrahlung parameters. The Bremsstrahlung parameters of (142)Pr as therapeutic beta nuclides in different human tissues (adipose, blood, brain, breast, cell nucleus, eye lens, gastrointestinal tract, heart, kidney, liver, lung deflated, lymph, muscle, ovary, pancreas, cartilage, red marrow, spongiosa, yellow marrow, skin, spleen, testis, thyroid and different skeleton bones) were calculated by extending the national council for radiation protection model. The specific Bremsstrahlung constant (Γ Br), probability of energy loss by beta during Bremsstrahlung emission (P Br) and Bremsstrahlung activity (A release)Br were estimated. It should be mentioned that Monte Carlo simulation was used for estimation of (142)Pr Bremsstrahlung activity based on the element compositions of different human tissues and the calculated exposures from the anthropomorphic phantoms. Γ Br for yellow marrow was smallest amount (1.1962×10(-3) C/kg-cm(2)/MBq-h) compared to the other tissues and highest for cortical bone (2.4764×10(-3) C/kg-cm(2)/MBq-h), and, overall, Γ Br for skeletal tissues were greater than other tissues. In addition, Γ Br breast was 1.8261×10(-3) C/kg-cm(2)/MBq-h which was greater than sacrum and spongiosa bones. Moreover, according to (A release)Br of (142)Pr, the patients receiving (142)Pr do not have to be hospitalized for radiation precautions and the Bremsstrahlung production does not prevent the therapy for outpatients. However, modeling (142)Pr source in water phantom for simulation of (142)Pr source in soft tissues could be acceptable due to similarity of Γ Br in water and soft tissues; this approximation is a gross computation in the mediums encompassing high atomic numbers. These data may be practical in the investigation of Bremsstrahlung absorbed dose where (142)Pr is involved in radionuclide therapy.

Validation of Imaging with Pathology in Laryngeal Cancer: Accuracy of the Registration Methodology

To investigate the feasibility and accuracy of an automated method to validate gross tumor volume (GTV) delineations with pathology, in laryngeal and hypopharyngeal cancer. High resolution CT (CTHR), MRI, and positron emission tomography (PET) scans were obtained from 16 patients before total laryngectomy. The GTV was delineated in each imaging modality, separately. The laryngectomy specimen was fixed with formaldehyde, embedded in a block of agarose, sliced transversely in 3-mm thick slices, photographed, and whole-mount hematoxylin-eosin stained sections were obtained. Tumor tissue was delineated in the hematoxylin-eosin sections by a pathologist. A landmark based registration was performed to register the hematoxylin-eosin sections to the thick-slice photos. Using the thick-slice photos, an automatic 3D reconstruction of the specimen was performed. The CTHR was automatically and rigidly registered to the 3D-specimen. The MRI and the PET were rigidly registered to the 3D-specimen using the CTHR as intermediate. The accuracy of the pathology-imaging registration and the specimen deformation and shrinkage were assessed. The tumor delineation inaccuracies were assessed as the distance between the surfaces of the imaging based GTVs and the gold standard delineation (based on the hematoxylin-eosin sections). The tumor delineation inaccuracies were finally compared with the registration errors, to estimate the limits of the validation of the GTV delineations with our registration method. Good agreement was observed between anatomical landmarks in the 3D-specimen and in the in vivo images. Limited deformations and shrinkage (3 ± 1%) were found inside the cartilage skeleton. However, deformations were observed outside the skeleton, particularly in the epiglottis. The root mean squared error of the registration between the 3D-specimen and the CT, MRI and PET was on average 1.5, 3.0, and 3.3 mm, respectively, in the cartilage skeleton. The GTVs delineated based on the hematoxylin-eosin sections, CT, MRI, and PET generated a mean volume of 7.2, 14.9, 18.3, and 9.8 mL, respectively. The tumor coverage by the CT, MRI, and PET delineation was on average 85%, 88%, and 77%, respectively. The tumor delineation inaccuracies exceeded the registration error for 62%, 38%, and 37% of the GTV surface points, for CT, MRI, and PET, respectively. Validation of GTV delineation with pathology is feasible with an average overall accuracy below 3.5 mm inside the laryngeal skeleton. The tumor delineation inaccuracies were larger than the registration error; therefore, an accurate histological validation of anatomical and functional imaging techniques for GTV delineation is possible, in laryngeal and hypopharyngeal cancer patients.

Validation of Imaging With Pathology in Laryngeal Cancer: Accuracy of the Registration Methodology

To investigate the feasibility and accuracy of an automated method to validate gross tumor volume (GTV) delineations with pathology in laryngeal and hypopharyngeal cancer. High-resolution computed tomography (CT(HR)), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans were obtained from 10 patients before total laryngectomy. The GTV was delineated separately in each imaging modality. The laryngectomy specimen was sliced transversely in 3-mm-thick slices, and whole-mount hematoxylin-eosin stained (H&E) sections were obtained. A pathologist delineated tumor tissue in the H&E sections (GTV(PATH)). An automatic three-dimensional (3D) reconstruction of the specimen was performed, and the CT(HR), MRI, and PET were semiautomatically and rigidly registered to the 3D specimen. The accuracy of the pathology-imaging registration and the specimen deformation and shrinkage were assessed. The tumor delineation inaccuracies were compared with the registration errors. Good agreement was observed between anatomical landmarks in the 3D specimen and in the invivo images. Limited deformations and shrinkage (3% ± 1%) were found inside the cartilage skeleton. The root mean squared error of the registration between the 3D specimen and the CT, MRI, and PET was on average 1.5, 3.0, and 3.3 mm, respectively, in the cartilage skeleton. The GTV(PATH) volume was 7.2 mL, on average. The GTVs based on CT, MRI, and PET generated a mean volume of 14.9, 18.3, and 9.8 mL and covered the GTV(PATH) by 85%, 88%, and 77%, respectively. The tumor delineation inaccuracies exceeded the registration error in all the imaging modalities. Validation of GTV delineations with pathology is feasible with an average overall accuracy below 3.5 mm inside the laryngeal skeleton. The tumor delineation inaccuracies were larger than the registration error. Therefore, an accurate histological validation of anatomical and functional imaging techniques for GTV delineation is possible in laryngeal cancer patients.

Regulation of the osteoblast-specific transcription factor Osterix by NO66, a Jumonji family histone demethylase

Osterix (Osx) is an osteoblast-specific transcription factor required for osteoblast differentiation and bone formation. Osx null mice develop a normal cartilage skeleton but fail to form bone and to express osteoblast-specific marker genes. To better understand the control of transcriptional regulation by Osx, we identified Osx-interacting proteins using proteomics approaches. Here, we report that a Jumonji C (JmjC)-domain containing protein, called NO66, directly interacts with Osx and inhibits Osx-mediated promoter activation. The knockdown of NO66 in preosteoblast cells triggered accelerated osteoblast differentiation and mineralization, and markedly stimulated the expression of Osx target genes. A JmjC-dependent histone demethylase activity was exhibited by NO66, which was specific for both H3K4me and H3K36me in vitro and in vivo, and this activity was needed for the regulation of osteoblast-specific promoters. During BMP-2-induced differentiation of preosteoblasts, decreased NO66 occupancy correlates with increased Osx occupancy at Osx-target promoters. Our results indicate that interactions between NO66 and Osx regulate Osx-target genes in osteoblasts by modulating histone methylation states.

Rhinoplasty Procedures

We have retrospectively assessed the charts of 166 patients who underwent rhinoplasties from March of 2005 to July of 2007, in the Plastic Surgery Department of the University of Torvergata Rome, Italy. From the operation chart of each patient, we filled out a form with the following details: access incisions to the nasal bone cartilage skeleton, maneuvers performed on the inferior lateral and superior cartilages, implants and/or grafts used, procedures made to the nasal base, types of osteotomies, and number of concomitant septoplasties. All the patients were operated under total anesthesia. The results were plotted on tables and graphs. In percentages, each surgical maneuver was separately analyzed, the need for grafts or incision in relation to the total number of patients operated, thus allowing for a numerical analysis of the approaches carried out in rhinoplasty procedures performed in our department.

The mother superior mutation ablates foxd3 activity in neural crest progenitor cells and depletes neural crest derivatives in zebrafish

The zebrafish mutation mother superior (mosm188) leads to a depletion of neural crest (NC) derivatives including the craniofacial cartilage skeleton, the peripheral nervous system (sympathetic neurons, dorsal root ganglia, enteric neurons), and pigment cells. The loss of derivatives is preceded by a reduction in NC-expressed transcription factors, snail1b, sox9b, sox10, and a specific loss of foxd3 expression in NC progenitor cells. We employed genetic linkage analysis and physical mapping to place the mosm188 mutation on zebrafish chromosome 6 in the vicinity of the foxd3 gene. Furthermore, we found that mosm188 does not complement the sym1/foxd3 mutation, indicating that mosm188 resides within the foxd3 locus. Injection of PAC clones containing the foxd3 gene into mosm188 embryos restored foxd3 expression in NC progenitors and suppressed the mosm188 phenotype. However, sequencing the foxd3 transcribed area in mosm188 embryos did not reveal nucleotide changes segregating with the mosm188 phenotype, implying that the mutation most likely resides outside the foxd3-coding region. Based on these findings, we propose that the mosm188 mutation perturbs a NC-specific foxd3 regulatory element. Further analysis of mosm188 mutants and foxd3 morphants revealed that NC cells are initially formed, suggesting that foxd3 function is required to maintain the pool of NC progenitors.

On the Development of the Feline Skeleton

To find precise data about the development of the skeleton of the domestic cat (Felis catus) embryological sections cleared specimens stained for bone and cartilage and radiographs were used (for details see our upcoming publication). The pre‐natal development is characterized by three main phases: the mesenchymal skeleton, already formed around stage 5 (Knospe, 2002) of the cat's development, with the notochord, somites, pharyngeal arches and limb buds, the cartilage skeleton arising during stage 14, and the bony skeleton formed by intramembranous and endochondral ossification from stage 16/17 on. The mesenchymal skeleton survives as periosteum in different ligaments, joint capsules, syndesmoses and inter‐vertebral disks. The cartilage skeleton is reduced up to birth to the epiphyseal and tympanic cartilages, and survives as laryngeal, tracheal, joint, rib, sternal, nasal cartilages and synchondroses. In the newborn cat all primary centres are present, except the carpal and distal tarsal bones, secondary centres aren not established radiographically yet. The secondary and tertiary centres are formed post‐natal from the first week on up to the second year. The results are presented in nine slides showing histological pictures with the main pre‐natal events and schemes of the post‐natal development with the skull, trunk and limb centres and their first appearance.

Tracheal reconstruction using a free jejunal flap with cartilage skeleton: experimental study.

An experimental study was undertaken to evaluate the behavior of an autologous microvascularjejunal transfer with a cartilage skeleton for major tracheal reconstruction in the goat model. A 15-cm segment of the cervical trachea was replaced by a free microvascularjejunal transfer with costal cartilage skeleton as a single-stage procedure. The flap was stented for 4 weeks with an endotracheal T-tube. Bronchoscopy was done to the survivors at 6 months. The perioperative mortality rate was 40 percent, with 30 percent of the animals surviving the 30-week follow-up period. Bronchoscopy showed a smooth and appropriate lumen. Histology showed hyaline cartilage integrated within the jejunal wall and normal jejunal mucosa. The reconstruction of a large circumferential tracheal defect with a free jejunal transfer with cartilaginous skeleton remained stable, without undue mucous secretion, and the surviving animals remained asymptomatic for the follow-up.

Salvage of a failed auricle replant with a temporoparietal fascia and subgaleal fascia flaps

A case of total auricle amputation is described in which microvascular replantation was attempted. A combined temporoparietal fascia and subgaleal fascia flap was planned as a lifeboat to preserve the cartilage skeleton of the ear, should the replant fail, as it indeed happened. The salvage procedure was done in the immediate postoperative period, with a long term acceptable result. The available options, along with other theoretical approaches to this problem, are discussed.