Incision and flap design during total auricular reconstruction using a 2-stage strategy

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Otolaryngology

Background:

• Total auricular reconstruction presents significant challenges for plastic surgeons.
• The expanded flap method and Nagata's method using autologous costal cartilage are leading techniques.
• A two-stage strategy employing an expanded flap method has gained attention.

Purpose of the Study:

• To report the specific incision and flap design for a two-stage expanded flap method in total auricular reconstruction.
• To evaluate the efficacy and outcomes of this novel surgical approach.

Main Methods:

• A kidney-shaped tissue expander (80 mL) was inserted in the mastoid region in the first stage.
• The second stage involved a Y-shaped incision for expander removal and separation of the remnant ear into three flaps.
• A pre-fabricated framework was integrated into the expanded flap, with simultaneous lobule transposition and tragus construction.

Main Results:

• The strategy was applied to 21 patients, with a follow-up ranging from 3 months to 1.5 years.
• 90.5% of patients reported satisfaction with the reconstructed ears.
• Minor modifications were needed in 14.3% of cases, with no serious complications.

Conclusions:

• A Y-shaped incision, three-flap design, and lobule rotation to an epidermal-removal area effectively facilitate tissue expander removal and ear modification.
• This technique avoids necrosis and the need for additional surgical procedures.
• The described method offers an effective solution for total auricular reconstruction.