Helical Rim Defects Research Articles

Simple local composite flap for a large superior helical rim defect

Simple local composite flap for a large superior helical rim defect

Earlobe‐based advancement flap for helical rim defect: A review of 30 cases

Earlobe‐based advancement flap for helical rim defect: A review of 30 cases

The Utility of Chondrocutaneous Advancement Flap in Conjunction with Postauricular SkinFlap for Reconstruction of Large Helical Rim Defects

The Utility of Chondrocutaneous Advancement Flap in Conjunction with Postauricular SkinFlap for Reconstruction of Large Helical Rim Defects

Modified Technique for Auricular Helical Rim Reconstruction in Adult Patients with Subtotal Helical Rim Defects.

In adults, the volume of costal cartilage is enough for reconstruction, but floating cartilage is hard, brittle, and easily broken due to calcification, in addition to being short, making it unsuitable for helical rim reconstruction in such age groups. This study describes a novel technique in which adult patients underwent 2-stage helical rim reconstruction using the syncytium of sixth and seventh costal cartilage. A single-arm clinical trial involves 35 adults with total and subtotal helical rim defects, either congenital, post-traumatic, postburn, or postvascular malformation excision. Twenty-nine unilateral and 6 bilateral cases. The age of patients ranged between 19 and 40 years. In the period between April 2021 and April 2023. Follow-up was 6 months. There were no technique-related complications, such as broken helix. In most cases, scars were invisible, with the normal contour of helical rim. Among the 35 patients, 19 were graded as excellent, 13 as good, and 3 as fair. In objective photographic evaluation, all patients were evaluated with high (3 or 4) ratings; the score was 3 in 19 patients and 4 in 16 patients. All patients were satisfied with the size, contour, position and details of the new helix. Using the syncytium of the sixth and seventh costal cartilage to fabricate the helical rim in adult patients gives a suitable volume of cartilage graft as regards the length and width, which suits the reconstruction of the helical rim, and shows a good configuration with satisfactory surgical results.

Modified Antia-Buch Flap Incorporating an Extended Temporal Scalp Incision.

The modified technique differs from the original Antia-Buch flap by completely detaching the root of the helix and adding a vertical incision to the temporal scalp to increase mobility of the flap. No scaphal resection is necessary. After complete elevation of the flaps, the flaps are advanced and inset toward each other followed by closure. In our practice, 10 patients have been treated with Noel et al's modification to the Antia-Buch flap. In each of these patients, acceptable reconstruction of the helical rim was able to be achieved. All the patients were pleased with their reconstructive outcome and ear anatomy was able to be successfully maintained. The modified Antia-Buch flap has shown to be an excellent method for large, helical rim defects, creating versatility by adding the temporal scalp incision. Our outcomes with Noel et al's modification to the original Antia-Buch flap support this method as a versatile technique for wide full-thickness helical rim defects.

Retroauricular hinge flaps for full-thickness conchal bowl defects

While there are several repair options for full-thickness helical rim defects and partial-thickness defects of the central ear, there are few repair options for full-thickness defects of the conchal bowl. A pedicled retroauricular flap has been described for repair of a full-thickness conchal bowl defect, but it is a 3-stage flap.1 For patients needing a single-stage repair, such as in patients with aggressive skin cancers requiring adjuvant radiation in a timely manner postsurgery, there are few options that maintain contour, size, and functionality of the central ear.

Use of Retroauricular Flaps to Reconstruct Defects of the Helical Rim and Adjuvant Intralesional Corticosteroids after Resection of Large Keloids.

The optimal treatment for large helical rim keloids remains unclear. The authors evaluated patient outcomes when retro auricular flaps were used to reconstruct helical rim defects and adjuvant intralesional corticosteroids were prescribed after resection of large keloids. The authors evaluated 7 females with 12 large keloids of the helical rim (5 patients had lesions in both ears). All patients were aged 18 to 33 years. The authors used retro auricular flaps to reconstruct the helical rim defects and prescribed adjuvant intralesional corticosteroids after resection. The lesion area ranged from 2.5 × 2.0 to 3.5 × 3.5 cm2. The flap size ranged from 2.5 × 3.0 to 3.5 × 4.5 cm2. The flaps and wound bases received 3 steroid injections at approximately 1, 2, and 3 months postoperatively. No flap necrosis or complications were noted. The postoperative esthetic results were satisfactory in 8 patients and excellent in 4. All patients were followed up for 14 to 28 months (median, 20.6 months). No recurrence was noted, although 3 patients exhibited mild scarring of the wound flap base. A retro auricular flap is safe and effective for reconstructing helical rim defects; adjuvant intralesional corticosteroids prevent scarring of the flap wound base after resection of large keloids.

Challenging Repair of a Helical Rim Defect.

Challenging Repair of a Helical Rim Defect.

Modified Chondrocutaneous Flaps for Middle Helical Rim Defects.

SUMMARY This article describes a unique approach for reconstruction of large helical rim defects. By raising bilateral chondrocutaneous flaps of the helical rim while including a semicircular chondrocutaneous excision of the adjacent scapha and antihelix, large defects can be repaired with minimal loss to the overall external ear circumference. This is a technically simple and reliable method that has resulted in excellent cosmetic outcomes and minimal morbidity in our practice.

Helical rim advancement flap and a diagonal wedge repair for a large ear defect

Large helical rim defects involving the auricular cartilage (Fig 1) can be difficult to repair and often require a 2-step reconstruction. Retroauricular scalp-to-ear interpolation flaps can repair large portions of missing skin but may need contralateral cartilage grafts for scaffolding.

Revisión sobre técnicas de reconstrucción del hélix por cáncer de piel

Introduction and objective: In this article we review the results of the reconstruction of the helical rim defects after the removal of the skin cancer. We Analyze the different methods of reconstruction and treatment modalities. Method: Narrative review in PubMed databases and search strategy: (((((((helical rim) OR helix)) AND defects) AND reconstruction) AND skin cancer. 46 articles were obtained in English or Spanish from which were selected 19 for the qualitative study. Results: More than half were reconstructed by simple single?step techniques; others required several reconstruction times. Discussion: There are several methods of surgical repair of helical rim defects. Small defects can usually be closed primarily with various wedge resections. For medium-sized defects, chondrocutaneous advancement flaps. Large defects typically need bipediculated tubing flaps or a temporoparietal fascial flap with skin and cartilage grafts. Conclusions: This mini review summarizes various reconstruction options for defects involving helical rim defects, facilitating rapid decision for surgeons according to the nature of the defect.

Helical Rim Reconstruction With Chondrocutaneous Hatchet Flap-Z Plasty.

Helical rim reconstruction is relatively difficult because of the unique anatomical structure of the ear. The aesthetic and functional characteristics of the ear make such reconstruction even more important. This article presents the newly defined chondrocutaneous hatchet flap-Z plasty (HFZP) method in helical rim defects and evaluates the results. This study retrospectively evaluates 14 patients who were operated on using the chondrocutaneous HFZP method after a tumor excision located on the helical rim. The etiologies of the patients were basal cell carcinoma (n = 7), squamous cell carcinoma (n = 2), and actinic keratosis (n = 5). All patients were operated on under local anesthesia. The patients were evaluated regarding age, sex, etiology, defect location, and aesthetic outcomes. Five patients were female, and 9 were male. The mean age of the patients was 72.2 years. Nine tumors were localized in the upper one-third of the helical rim, and 5 were localized in the middle one-third. The average duration of operation was 24 minutes. The aesthetic results were 11 patients (78.59%) who recovered with excellent outcome, 2 patients (14.2%) with good outcome, and 1 patient(7.1%) with poor outcome. There were no postoperative complications, such as flap necrosis, infection, suture detachment hemorrhage, or hematoma. The chondrocutaneous HFZP method is a simple, single-stage method that uses local tissues without color mismatch. In addition to the method's geometric gain, there is no removal of healthy skin or cartilage, resulting in minimal decreases in the vertical and horizontal diameters of the ear.

Superior Antia-Buch flap for reconstruction of helical rim defects

A 63-year-old woman had undergone surgery for malignant lentigo melanoma in the helical rim (Fig 1).

Results of auricular helical rim reconstruction with post-auricular tube flap.

The aim of the study was to present our experience with post-auricular tube flap (ptf) and clinical evaluation of the results following auricular helical rim reconstruction with this technique in patients after trauma. We analyzed the results in 12 patients who underwent three-staged auricular helical rim reconstruction with ptf following trauma in the Department of Plastic, Reconstructive and Aesthetic Surgery between 2005-2014. The patients were followed-up for at least 1 year. We evaluated early and long-term results after surgery including plastic surgeon's and patient's opinion. Postoperative results were satisfactory (very good) in 10 cases, both in the opinion of the plastic surgeon and patients. Transient venous congestion of the helix occurred in two cases (16.6%). This complication did not have any influence on estimation of the results after surgery. Delayed wound healing in the poles of the reconstructed helical edge, as well as non-aesthetic helical scars with imperfections of helical rim, were seen in another two patients (16.6%). 1. Post-auricular tube flap reconstructions after helical rim trauma allowed for complete restoration of contour, size and orientation of the helix and the whole operated ear, which confirms the efficiency of the applied technique. 2. Reconstructive surgery with post-auricular tube flap in patients with auricular helical rim defects contributed to postoperative satisfaction in both patients and doctors' estimations.

The arterial blood supply of the helical rim and the earlobe-based advancement flap (ELBAF): A new strategy for reconstructions of helical rim defects

Several techniques are currently available for reconstruction of helical rim defects including Antia and Buch's technique. Some of these techniques produce unsatisfying aesthetic results or are time consuming or technically challenging. Herein, we present the earlobe-based advancement flap (ELBAF) technique and its anatomical basis for reconstruction of helical rim defects. A case series of 13 patients with helical rim defects of up to 3.8cm in length were reconstructed using the ELBAF technique solely or with additional procedures. Patients were followed for the occurrence of complications and evaluation of aesthetic results for up to 8 years. An anatomical assay that included cadaver dissection and anatomical corrosion technique was performed in order to support the ELBAF technique. Thirteen patients (68.5±9 years, two females) with full-thickness helical rim defects of up to 3.8-cm length caused by basal cell carcinoma in 92.3% underwent reconstruction surgery using the ELBAF technique solely or with additional procedures. No complications related to the ELBAF technique were encountered during follow-up. Cadaver dissections demonstrated a consistent arterial blood supply emerging from the earlobe area, producing arteries that run circularly along the helical rim. Based on the axial vessel pattern, the ELBAF technique seems to be a useful strategy to reconstruct full-thickness helical defects of up to 3.8cm in length. This procedure can be regarded as a valid addition to the ear reconstruction repertoire, which can be used alone or in combination with other established techniques. Level 4, case series.

Modified Antia–Buch flap for the reconstruction of helical rim defects

The Antia-Buch flap is a sophisticated one-stage procedure using two chondrocutaneous flaps to reconstruct the ear helix. Because tissue laxity is largely conferred by the inferior flap, relative to the less mobile superior flap, chondrocutaneous resection of scapha is required for closure. This results in loss of ear height and limits morphologic outcome. We describe a modification of the Antia-Buch flap, which may avoid such drawbacks. We conducted a retrospective review of patients (n = 15), each undergoing our modified Antia-Buch flap between 2010 and 2014. All procedures were performed under local anesthesia as outpatient procedures. Data on magnitude of resections, procedure durations, related complications, and aesthetic outcomes were collected. The mean size of resection was 25 mm (range, 20-30 mm). The modification improved the mobility of the upper chondrocutaneous flap, eliminating the need to resect the scapha. All wounds healed uneventfully, with no skin necrosis. The morphologic outcome was satisfactory or very satisfactory in all patients, preserving the shape, height, and width of the ear. Our modification changes the upper flap from an advancement flap to a transposition flap, enhancing its mobility and preempting the resection of the scapha. Thus, anatomic landmarks, aesthetic subunits of the pinna, and ear height are maintained for highly satisfactory morphologic results. 4.

The ‘double headed slug flap': A simple technique to reconstruct large helical rim defects

Reconstructing partial defects of the ear can be challenging, balancing the creation of the details of the ear with scarring, morbidity and number of surgical stages. Common causes of ear defects are human bites, tumour excision and burn injuries. Reconstructing defects of the ear with tube pedicled flaps and other local flaps requires an accurate measurement of size of the defect with little room for error, particularly under estimation. We present a simple method of reconstruction for partial defects of the ear using a two-stage technique with post auricular transposition flaps. This allows for under or over estimation of size defects permitting accurate tissue usage giving good aesthetic outcomes.

Successful Reconstruction of a Large Helical Rim Defect Using Retroauricular Artery Perforator-Based Island Flap

The retroauricular flap has many applications, providing coverage for various portions of the face as a pedicled flap or a free flap. The retroauricular skin, having similar attributes to the facial skin, is an ideal donor site for facial reconstruction. Also, the donor site can be primarily closed without morbidity, which is also an advantage. In this article, a large helical defect resulting from a traumatic amputation was reconstructed using the contralateral conchal cartilage graft and a retroauricular perforator-based island flap. Using the "perforator pedicled propeller flap" concept, no meticulous dissection around the perforator was done, and the flap was elevated only until sufficient rotation arc was achieved. There was some degree of venous congestion on the flap for 3 days postoperatively, but the flap survived completely. By using the conchal cartilage from the contralateral side, the final contour of the ear was maintained aesthetically. The flap had some bulkiness on the posterior side of the auricle where it was transposed, but it was inconspicuous on frontal or lateral view because the conchoscaphal angle had not changed. The patient was satisfied with the aesthetic results. The retroauricular flap is useful for resurfacing any portion of the ear, and by using the propeller flap method, significant reduction in operative time can be achieved without compromising the final results.

Double Helical Rim Advancement Flaps With Scaphal Resection: Selected Cases Over 10 Years and Review of the Literature

Auricular surgery is a challenging subject in plastic surgery due to the complicated surface topography of the external ear. Although various techniques for ear reduction and helical rim reconstruction have been reported in the literature, an ideal method is yet to be defined. Double helical rim advancement flaps with scaphal resection presented in this report represent a practical technique for correcting macrotia and reconstructing helical rim defects. The amount of full-thickness resection at the helical rim is planned according to the desired reduction or extent of tumor. After helical excision, an incision that transects all the layers of the ear is carried out along the helical sulcus inferiorly and superiorly to yield two advancement flaps. Using scissors, a crescent from the scapha is excised through the full thickness of the ear. The flaps are approximated and sutured to the scapha by means of stitches that pass through skin and cartilage. The described technique has been performed successfully since 1998. It has been used for 12 cases of macrotia, 28 cases of tumor surgery, and 7 cases of ear reduction for asymmetric ears. No major complications have been encountered. Three cases are reported as examples of the procedure. Double helical rim advancement flaps with scaphal resection represent a versatile and safe technique that can be used for ear reduction, helical rim reconstruction, and correction for discrepancy in size of ears.

Bilobed flap for reconstruction of defects of the helical rim and posterior ear

When contemplating the repair of defects involving the ear, second intention healing and full or split thickness skin grafts are often considered for reconstructive choices. Closing the combined full thickness helical rim and posterior ear defects, however, represents a reconstructive challenge because of the lack of available freely mobile skin anteriorly, superiorly, and inferiorly to the defect. The choice of the bilobed flap circumvents this challenge by rotating the skin and recruiting the tissue from the post-auricular sulcus, the lower pole of the posterior ear, and, if necessary, from the superior area of the neck adjacent to the posterior ear. This bilobed flap also enables an inconspicuous closure of the donor site and provides sufficient blood supply to ensure flap viability in a simple one-stage repair. Herein, we describe two cases in which we used the bilobed flap to rotate skin from the post-auricular surface to reconstruct full thickness skin defects involving the helical rim and posterior ear, with excellent cosmetic results.