Ear Reconstruction Flashcards
(39 cards)
What is the initial treatment for partial-thickness defects with intact perichondrium?
Cover with skin graft taken from contralateral postauricular region.
What procedure is followed for partial-thickness defects with missing perichondrium?
Wedge excision is made (<1.5 cm defect) and preauricular or postauricular flaps are rotated, advanced, or tunneled through cartilage into defect.
What is a two bipedicle flap technique used for?
Used for partial thickness defects, based on posterior skin and advanced anteriorly.
What is a critical tip for partial thickness defects?
For partial thickness defects, with or without missing perichondrium in noncritical support areas (such as the conchal bowl), excision of the cartilage will leave the bare area of the postauricular skin as a well-vascularized recipient site for a full-thickness skin graft. Be sure to use bolster dressings with through-and-through stitches to stabilize the graft.
What is the treatment for small helical rim defects (<2 cm)?
Contralateral composite graft (<1.5 cm defect) or Antia-Buch procedure.
What is the Antia- Buch procedure used for?
Describe the steps of the Antia-Buch procedure.
Downsides?
Used for upper 1/3 helical defects
The base of the helicopter is advanced in V-Y fashion and coupled with helical rim advancement.
1. Incision is made in helical sulcus through anterior skin and cartilage;
2. Posteromedial skin is undermined;
3. Helix is advanced into defect based on posterior skin flap.
Can result in decrease in height of ear
What types of flaps are used for middle and lower helical defects?
Chondrocutaneous rotation flaps based on antihelix, antitragus, or lobule. Defects up to 5 cm can be closed by including a lobule advancement flap and scapha resection
What is the treatment for large helical rim defects (>2 cm)?
Auricular cartilage grafts are covered by preauricular flap or staged postauricular pocket flap
— Converse’s Tunnel technique/ Converse flap
— Tubed pedicle flaps
How do you perform Converse’s tunnel technique, and what is it used for?
It is a chondrocutaneous transposition flap
Stage 1: Contralateral auricular cartilage strut graft tunneled under postauricular skin adjacent to helical defect;
Stage 2: Anteriorly based skin flap and underlying cartilage strut inset into helical rim as composite flap after 3 weeks.
Used for helical rim defects > 2 cm, large middle 1/3 defects
What is the valise handle technique used for?
Used for bipedicled chondrocutaneous flaps in large defects (> 2 cm) of the superior third of the auricle.
How do you perform the valise handle technique?
♦ Stage 1: Contralateral auricular cartilage graft is implanted subcutaneously adjacent to defect.
♦ Stage 2: After 3 weeks, inferior helix is transposed to cartilage graft.
♦ Stage 3: After 3 more weeks, bipedicled composite flap is elevated as a “valise handle” skin graft to posterior sulcus to achieve projection of helix and definition of inferior crus.
What is the purpose of the chondrocutaneous composite flap from conchal bowl?
Used when flap skin is unavailable for coverage of cartilage graft.
Can be based anteriorly on root of helix (Davis) or laterally as described or Orticochea
What is involved in the treatment of small middle third defects (<2 cm)?
Auricular reduction using Tanzer’s excision patterns and primary closure.
Describe the ‘Flip-flop’ flap technique.
♦ For conchal defects, a postauricular island flap is elevated that includes the skin, a portion of the postauricular muscle, and fascia and is based off the posterior auricular artery; if there is no defect in the conchal cartilage, one is created to allow passage of the flap anteriorly to fill the defect.
♦ The flap is then rotated anteriorly 180 degrees, so that the posteriormost aspect of the flap becomes anterior along the antihelix, and the anteriormost portion of the donor flap is deep in the conchal bowl; the donor site is then closed primarily by advancing the remaining postauricular skin, which shallows the posterior sulcus slightly.
What is Dieffenbach’s flap technique for larger middle third defects?
♦ Stage 1: Contralateral auricular cartilage graft is sutured to defect; postauricular skin is elevated, then advanced over cartilage graft to fill defect.
♦ Stage 2: Postauricular skin flap is divided 3 weeks later.
What is the treatment for inferior third defects?
Superiorly based flaps doubled over with subcutaneous cartilage graft for contour and support.
Valise handle technique for bipedicled chondrocutaneous flaps can be modified for lower defects to achieve definition of posterior conchal wall.
What is the procedure for earlobe defects?
- Composite graft from contralateral lobule
- Postauricular flap transposed to superiorly based anterior skin flap.
- Chondrocutaneous flaps from the postauricular surface can be rotated interiorly, based on a subcutaneous pedicle, to reconstruct the anterior surface of the lobule; the posterior surface of the lobule can be reconstructed with a local retroauricular skin flap.
▸ The inclusion of conchal cartilage prevents scar contracture.
▸ The donor defect is closed primarily by advancing retroauricular skin.
What is the cleft earlobe reconstruction technique?
Wedge excision and everted closure
Z-plasty closure to prevent notching
What is required for replantation?
The superficial temporal artery or posterior auricular artery must be available for microvascular anastomosis.
Venous anastomosis not required, but there is a hair risk of partial flap or ear loss
What is the role of leech therapy in replantation?
Leech therapy is often required even if a venous anastomosis (to superficial temporal vein) is performed.
What is Mladick’s pocket principle for banking ear cartilage? Where can you bank ear cartilage?
Dermabrasion removes epidermis, cartilage is reapplied and banked under postauricular skin pocket.
Cartilage is reapplied to the remaining ear and banked under a postauricular skin pocket.
The graft is left in place for 3 weeks and will reepithelialize when exposed.
Traumatized ear cartilage can be banked under temporoparietal fascia, postauricular skin, or volar forearm
What does Baudet’s fenestration technique involve?
Technique for banking cartilage. Removes posterior skin of the amputated part, and makes fenestrations in avulsed auricular cartilage to increase vascular recipient area. The amputated portion is reattached, and exposed cartilage is covered with postauricular skin flap. Flap is divided after 3 months and skin graft is applied.
TIP: The temporoparietal fascia flap should be preserved for secondary reconstruction; its use for acute coverage of replanted cartilage is not recommended.
What are options for total ear reconstruction?
Framework covered with free or pedicled temporoparietal fascial flap and skin graft, or tissue-expanded periauricular skin. the underlying framework can either be sculpted costal cartilage or a prefabricated Medpore implant.
What is preferred for costal cartilage frameworks? How does its use differ in kids vs. adults?
Contralateral costal synchondrosis (ribs 6-8) is preferred.
• The cartilage is flexible in children, and the helical rim can be created by attaching a separate carved piece of rib cartilage to the framework. • The cartilage is stiff in adults, and the framework, including the helical rim, is best carved en bloc, because cartilage does not tolerate bending. • The framework should be based on a template from the contralateral ear to match size and contour.
