Postauricular Surface Research Articles

A new approach to assess the effect of photodamage on corneocyte envelope maturity using combined hydrophobicity and mechanical fragility assays.

The maturity of the corneocyte envelope (CE) provides information about the barrier functionality of the stratum corneum (SC). Corneocytes are enclosed by the CE, a protein-lipid matrix, contributing to mechanical resistance and hydrophobicity of the SC. The aim of the work was to develop a novel and robust approach to characterize CE maturity based on rigidity, hydrophobicity and surface area. This offers an alternative approach to the Nile red staining and antigenicity of involucrin to characterize the CE. The photoexposed (PE) cheek and photoprotected (PP) post-auricular sites were selected for investigation. Nine tape strips were obtained from the cheek and post-auricular sites of healthy Caucasians. CEs on the first and last tape strip were subjected to sonication to assess rigidity, and Nile red staining to determine hydrophobicity per unit surface area. In addition, the presence of involucrin and lipids was assessed to determine CE maturity by examination of the red/green pixel ratio, percentage of involucrin expressing CEs and alternatively the ratio of fluorescence density. The CE rigidity was lower in the deeper SC layers of the cheek, whereas post-auricular CEs were mechanically more resistant. Post-auricular CEs from the superficial SC had a larger surface area with a stronger fluorescence signal than those from the cheek. Interestingly, those CEs from the deeper SC layers had similar surface areas in both anatomical sites but were significantly different in hydrophobicity. These three parameters can be summarized as a relative CE maturity index that expresses CE maturity more precisely with a higher sensitivity than the conventional involucrin and Nile red staining approach. CEs of the cheek surface are more mature than CEs in the deeper SC layer, whereas CEs obtained from the post-auricular surface are more mature than those from the cheek surface. The combined method developed allows characterization of CE maturity based on hydrophobicity per unit surface area and rigidity rather than a simple ratio of lipid to involucrin. A more robust and sensitive measurement has therefore been developed addressing the limitations of earlier protocols.

An Alternative Posterosuperior Auricular Fascia Flap for Ear Elevation During Microtia Reconstruction.

Advances in staged total auricular reconstruction have resulted in improved anterior auricular appearance; however, satisfactory postreconstruction esthetics of the retroauricular fold remain challenging. The postauricular appearance of the reconstructed ear depends largely upon optimizing the covering material. When used as the covering soft tissue for ear elevation, a flap containing primarily the upper portion of the retroauricular fascia has potential advantages over the conventional book cover-type retroauricular fascia flap. We developed a geometrically designed, posterosuperior auricular fascia flap to replace the conventional retroauricular fascia flap for ear elevation. During the second-stage operation, the posterosuperior auricular fascia flap is rotated downward and turned over to wrap around the inner strut and entire posterior auricular surface. Compared to the conventional book cover-type retroauricular fascia flap, the novel posterosuperior auricular fascia flap was easier to harvest and the operative time significantly decreased (110.3 vs. 121.5min, p<0.01). The modified flap produced a thin and natural contour of the postauricular surface, as well as reduced the incidence of postauricular hypertrophic scarring (from 24.7 to 13.2%, p=0.03) and partial skin graft necrosis (from 43.4 to 31.2%, p=0.01). The geometrically designed posterosuperior auricular fascia flap improves ear elevation. Compared to the conventional book cover-type retroauricular fascia flap, this covering tissue is easier to perform so the surgical time is decreased. It was highly vascularized, well defined, thinner, and yields reliable results. Thus, favorable postauricular surface results can be achieved during auricular reconstruction by using the modified fascia flap. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Simple Modified Flip-Flop Flap for the Reconstruction of Antihelix and Triangular Fossa Defects.

A Simple Modified Flip-Flop Flap for the Reconstruction of Antihelix and Triangular Fossa Defects.

Correction of Lobule-type Microtia: Part 2: The Stage of Ear Elevation.

Background:Here, we introduce our recent operative technique for ear elevation that results in (1) minimal morbidity for patients, (2) symmetric appearance, (3) clearer 3-dimensional structure with a deep concha, (4) good aesthetic appearance by hiding the grafted area behind the ear, and (5) maintenance of deep temporoauricular sulcus and angle.Methods:After a skin incision, the ear is elevated with temporoparietal fascia underlying the cartilage. On the conchal area, undermining is performed just below the skin so that the deep concavity can be maintained. Scalp and neck skin behind the ear is undermined subcutaneously and lifted up cranially to hide the entire area of grafted skin behind the ear. The postauricular surface is covered by full-thickness skin from the lower abdomen. A protective splint is applied for 3 months while sleeping.Results:A total of 137 ears in 121 patients were corrected with our technique and followed up for at least 3 years. All of the scar tissue could be hidden behind the ear, an aesthetically excellent result.Conclusions:Our technique made it possible to acquire an excellent and symmetrical shape of the ear. The important points in our procedure are as follows: (1) subcutaneous posterior undermining to enlarge the conchal cavity, (2) careful arrangement of the temporoauricular angle and auriculo-earlobe angle, (3) reduction in the area of temporally grafted skin to hide all scars behind the ear, and (4) protection of the ear to maintain the shape using a postoperative splint.

Implantation cochléaire des cochlées ossifiées post-méningitiques : à propos de 30 implantations

A large Z-plasty on the postauricular surface of the ear has been used for successful reconstruction ofcryptotia. This technique provides extensive skin coverage of the posterior auricle without skin grafting. The technique is easy and simple. The natural hairline is not disturbed and the temporoauricular sulcus is emphasised. Almost all of the scar is hidden behind the auricle. It has been performed on 17 patients with no recurrence of the cryptotia. One patient had partial congestion in the cranial-flap tip, which improved within 1 week. There were no other complications.

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.

Auricular reconstruction with the use of a modified rhomboid flap

Sir, We describe a simple, safe one-stage procedure for reconstruction of marginal helical defects. Auricular reconstruction after trauma, burn or local excision of tumours has been a common challenge in plastic surgery. Apart from functional importance, the ear also has great aesthetic value, because it frames the face and provides symmetry. A common defect on the ear is partial loss of the helical margin with or without a cartilage defect. Keeping general principles in mind, one can consider various surgical options, based on a reconstructive triangle approach. One effective solution is the use of the rhomboid flap [1]. The skin defect over the superior part of the ear can be covered by a superiorly based random pattern post-auricular flap designed on the non-hair bearing area, this has the advantage of having the same skin colour as the original auricular skin (Figs. 1, 2, 3 and 4). Although the dimensions and shape of both defect and flap are precise, they are variables in planning, namely which of four potential flaps should be used, and the axis around which the excisional rhomboid is be drawn. It is possible to manipulate these variables in such a way that closure of the secondary defect makes use of the laxity of the skin present (use of Dufourmental instead of Limberg flap). A further advantage of this flap is that the donor site scarring comes to lie behind the ear and is, therefore, inconspicuous. The anterior edge of the flap can be cut along the retroauricular sulcus. The greater skin mobility on the post-auricular surface, coupled with the fact that ear tolerates being set back closer to the head, increases the role of this flap considerably. There is some loss of the curve of the helical margin, but patients tend to be in an older age group and thus the result can be acceptable. For small defects, a simple transposition flap that is designed as a formal rhomboid flap is a useful option (Figs. 5, 6). In this situation, Fortier-Riberdy et al. gave some useful tips [2]:

Adjuvant Radiation of Bilateral Postauricular Keloids: An Illustration of Technique

Treatment of keloids can be diverse and, frequently, in cases of recurrence, patients are referred for postoperative radiation therapy. Some sites known for keloid formation, such as the postauricular surface, can create a technical challenge. Because of the need for treatment so soon after surgery, physical manipulation of the freshly operated area to accommodate exposure for electron (or other) therapy is difficult. We were recently asked to evaluate a patient requiring treatment of both postauricular spaces. Literature describing techniques for such a case is scant, and we felt it would be helpful to describe and depict our setup and treatment course.

A new operative method of correcting cryptotia using large Z-plasty

A large Z-plasty on the postauricular surface of the ear has been used for successful reconstruction of cryptotia. This technique provides extensive skin coverage of the posterior auricle without skin grafting. The technique is easy and simple. The natural hairline is not disturbed and the temporoauricular sulcus is emphasised. Almost all of the scar is hidden behind the auricle. It has been performed on 17 patients with no recurrence of the cryptotia. One patient had partial congestion in the cranial-flap tip, which improved within 1 week. There were no other complications.

Subfascial expansion and expanded two-flap method for microtia reconstruction.

This article presents an improved two-flap method for microtia reconstruction. In the first stage of this method, a tissue expander is inserted in the mastoid region through a subfascial pocket, after which the overlying fascia and skin are expanded simultaneously with saline infusion for about 5 months. In the second stage, the expanded fascial and skin layers are split and prepared as anteriorly based skin and fascial flaps defined by their vascularity. An erect, three-dimensional, contour-accentuated ear framework fabricated with autogenous rib cartilage is inserted between the two flaps. The anteroauricular surface of the framework is draped with the thin, expanded skin, and the postauricular surface is draped with the thin, expanded fascia and overlying grafted skin. In the third stage, remnant auricular cartilage is removed and the crus helicis, tragus, intertragic notch, conchal floor, and a hollow mimicking the external auditory meatus are shaped. In this study, 146 microtias were reconstructed consecutively using the improved two-flap method. The final results were promising--major complications were minimal and most patients showed consistently favorable aesthetic results. This method married a two-flap procedure with a gradual tissue expansion, conveniently exploiting the advantages of both methods, but without the disadvantages.