Microtia reconstruction using tissue expanders without skin grafts from groin region.

Microtia reconstruction is a multistage procedure for which a variety of surgical strategies have been devised. Most surgeons continue to employ the long-established two-stage procedures described by Nagata and Firmin, which use autogenous rib cartilage for auricular reconstruction. The groin area is the most common donor site for full-thickness skin grafts in auricular elevation, the second stage. In this article, we present a new method that uses tissue expanders before auricular elevation, which provides the necessary skin and creates satisfactory results without groin scarring. The surgical procedure is composed of three stages. In the first stage, we performed the rib-cartilage graft as previously described. In the second stage, a 45-ml rectangular tissue expander was inserted subcutaneously at the postauricular mastoid region. The skin flap was expanded for 3-4 months before auricular elevation. In the next stage, the expanded postauricular skin flap was advanced to the mastoid area and set into the auriculocephalic sulcus after removing of the tissue expander. The estimated remnant skin flap and dog-ears were marked and then excised. After a defatting procedure, the harvested skin was reused for the elevation procedure, obviating the need for full-thickness skin from the groin. Between January 2011 and January 2014, 62 cases of microtia were treated with our method. The final results showed no major complications and satisfactory aesthetics, with fine structure, symmetry, maintenance of the auriculocephalic angle, and erect stability of the cartilage framework. Various procedures using tissue expanders have been introduced in microtia reconstruction. However, they utilized complicated strategies for tissue expanders or obtained suboptimal aesthetic results. With our simple and reproducible methods, we can obtain satisfactory aesthetic results using expanded skin without the additional morbidity of a donor site. Despite the addition of an operation procedure, patient satisfaction with regard to the lack of groin scarring was much higher than expected.

Park BY ，Im JT ，Lim SY ，Pyon JK ，Bang SI ，Mun GH ，Oh KS ... -  《-》

A new strategy for total auricular reconstruction using prelamination of an extended retroauricular flap with tissue expansion.

To accomplish total ear reconstruction with aesthetic appearance is a great challenge for plastic surgeons worldwide due to insufficient skin coverage. A retroauricular fascial flap and skin graft technique are commonly used, but the results obtained are not satisfactory due to color mismatch, severe edema, and donor-site morbidity. Here, we describe a novel strategy for total ear reconstruction, utilizing an extended retroauricular flap prelaminated with tissue expansion to obtain enough skin for ear reconstruction. About 2 months before ear reconstruction, a kidney-shaped tissue expander was inserted at the mastoid region subcutaneously. The retroauricular skin became enlarged and thinner in 2 months after expansion. Next, the expander was removed and the retroauricular flap was extended by dissecting the surrounding scalp subcutaneously. By mobilizing the scalp-extended retroauricular flap, we could encapsulate the entire framework with thin and non-hair-bearing skin. From August 2014 to September 2015, 36 microtia patients had undergone ear reconstruction using the novel strategy. Satisfactory aesthetics along with fine structure, symmetry, and maintenance of the auriculocephalic angle was achieved in all patients. Using our novel strategy, we can obtain satisfactory aesthetic outcomes by fully mobilizing the expanded skin without additional morbidities of the donor sites. Patients are satisfied with the vivid ear contour and lack of groin scar.

Li C ，Jiang H ，Huang C ，Chen J ，Wu R ，Bi Y ，Yang M ，Zhang Y ，Pan B ... -  《-》

Reconstruction of Microtia Using a Single Expanded Postauricular Flap without Skin Grafting: Experience of 683 Cases.

Xing W ，Kang C ，Wang Y ，Zhang Q ... -  《-》

Expanded retroauricular skin and fascial flap in congenital microtia reconstruction.

Zhang Q ，Quan Y ，Su Y ，Shi L ，Xie Y ，Liu X ... -  《-》

Auricular reconstruction using a novel three-flap technique improves the auriculocephalic angle.

Skin grafting is needed for traditional auricular reconstruction. As the skin grafts contract, the postoperative framework is distorted. This leads to a decrease in the auriculocephalic angle. The objective of this study was to test a new method to cover the reconstructive framework by using three skin flaps and a larger tissue expander than that normally used. This may reduce the distortion of the reconstructed ear and create a well-shaped auriculocephalic angle. A large expander was inserted in the postauricular mastoid area. Three expanded flaps were then created to cover the anterior and posterior frameworks, with separate mastoid coverage. By measuring the height and angle at three different points on the reconstructed ear and comparing them with the contralateral normal ear, a system for measuring the auriculocephalic angle was established. The surface of the framework and the mastoid area were covered by three flaps developed from one large tissue expander. The appearance of the reconstructed ears was similar to that of the normal side by the patient's 6- to 12-month follow-up. The difference in the distance at the three points between the reconstructed and normal sides after the three-flap reconstruction was less than that following traditional reconstruction (p < 0.05). The variation in the angle measured at these three points in the three-flap group was also much smaller than that in the traditional group (p < 0.01). The three-flap technique not only improves the appearance of the reconstructed ear, but helps shape a perfect auriculocephalic angle.

Jiafeng L ，Jiaming S ，Xiaodan L 《-》