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Salvage of Ear Framework Exposure in Total Auricular Reconstruction

 Kim, Young Soo  ;  Yun, In Sik  ;  Chung, Seum 
 Annals of Plastic Surgery, Vol.78(2) : 178-183, 2017 
Journal Title
 Annals of Plastic Surgery 
Issue Date
Adolescent ; Adult ; Cartilage/transplantation ; Child ; Congenital Microtia/surgery* ; Ear Auricle/pathology ; Ear Auricle/surgery* ; Female ; Humans ; Male ; Middle Aged ; Necrosis/etiology ; Necrosis/surgery ; Polyethylenes ; Postoperative Complications/surgery* ; Prostheses and Implants ; Reconstructive Surgical Procedures/instrumentation ; Reconstructive Surgical Procedures/methods* ; Reoperation ; Salvage Therapy/methods* ; Skin Transplantation ; Surgical Flaps ; Transplantation, Autologous ; Treatment Outcome ; Wound Healing
salvage procedure ; ear framework ; microtia reconstruction
BACKGROUND: One of the most common complications of total auricular reconstruction is delayed wound healing, which results in skin necrosis and exposure of the ear framework. Various options exist for salvage of the exposed ear framework. METHODS: From January 2009 to May 2014, 149 patients underwent total auricular reconstruction using an autogenous cartilage framework or porous polyethylene framework (Medpor; Stryker, USA). An autogenous cartilage framework was used in 48 patients, and a Medpor framework was used in 101 cases. Three cases of framework exposure (3/48, 6.3%) were observed among the patients treated with an autogenous cartilage framework. In contrast, framework exposure took place in 11 patients who were treated with a Medpor framework (11/101, 10.9%). Depending on the method of total ear reconstruction and the location of exposure, the authors used local skin flaps, temporoparietal fascia flaps, deep temporal fascia (DTF) flaps, or mastoid fascia (MF) flaps with skin grafting. RESULTS: Among the 11 patients who experienced framework exposure after being treated with a Medpor framework, a DTF flap with skin grafting was used in 6 patients and an MF flap with skin grafting in 6 patients; 1 patient was treated with both a DTF flap and an MF flap. All 3 cases of cartilage framework exposure were salvaged using a temporoparietal fascia flap with skin grafting, and a local skin flap was used in 1 case. In all 3 cases, the exposed framework was completely covered with the flap, and the reconstructed ears showed well-defined convolutions. CONCLUSIONS: Salvage of framework exposure remains a challenging issue in total auricular reconstruction. However, appropriate wound management using various flaps allows the reconstructed ear to be safely preserved.
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
윤인식(Yun, In Sik) ORCID logo https://orcid.org/0000-0003-1103-7047
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