Reconstruction of the anterior surface of the ear using a postauricular pull-through neurovascular island flap. Reconstruction of auricular defects arising from trauma or oncologic resection aims to restore the natural anatomic structures and landmarks of the ear and ideally should maintain balance and symmetry with the contralateral ear. In plastic surgery: A one-sided mound of redundant tissue, which is seen after the repair of certain skin lesions and defects. (B) Posterior auricular artery and branches. The lobule has great variability in its length and curvature. Medially, these ridges bound the concha. Skin flap surgery is done to treat large wounds that cannot be closed by skin grafting. They are common at the sides of tummy tuck incisions or the end of breast reduction scars. The auriculotemporal nerve, a branch of V 3 , supplies the lateral aspect of the superior portion of the helix. Flaps Uses1. Sel Read Plast Surg. Grafts will have the highest chance of surviving if there is intact perichondrium. Inferiorly based postauricular flaps can also be used for ear lobe reconstruction (see chapter on Reconstruction of the Ear Lobe). With its numerous ridges and valleys designed to improve acoustic reception, the external ear possesses the most complex topography of any cosmetic unit of the head and neck. It can also be more easily removed to inspect the graft should that be necessary. The innervation is supplied by branches of the cervical nerve, 10th cranial nerve, trigeminal nerve, and lesser occipital nerve. The scapha is the concave rim that separates the helix and antihelix. Plastic surgery of the face is, in the rst instance, surgery of the skin. Antia NH, Buch VI. Although the recessed nature of the concha makes it appear less important to the structure of the auricle, it actually acts as a brace between the mastoid and the remainder of the auricle. Versatility of the posterior auricular flap in partial ear reconstruction. The posterior auricular artery supplies the entire medial (posterior) surface and has branches that perforate to the opposing surface, mainly supplying the lower half of the ear including the conchal bowl ( Fig. At the Johns Hopkins Melanoma Program, patients are offered the complete spectrum of care: from diagnosis, resection, complex reconstruction, and follow-up, all in one area, by the best trained surgeons who are at the forefront of surgical care and research. Full-thickness skin grafts have a wide application in resurfacing small to medium auricular defects. 6 WEEKS Usually require either laser resurfacing or dermabrasion to give nicest result. Philadelphia: Lippincott-Raven; 1997. Guo P, Pan B, Jiang H, et al. Once the otoplasty surgery is complete, the patient's head will be wrapped with special heavily-padded cotton bandages, referred to as "fluff bandages", for healing. Because of the location from with tissue is borrowed, LAP flap surgery lifts the buttock and contours the waistline. This rich anastomotic network of blood vessels is the basis for the postauricular flap. Important words to know for cosmetic and reconstructive plastic surgery. Ear reshaping surgery in Houston and Webster, Texas, at Houston Plastic and Reconstructive Surgery is a plastic surgery procedure performed to improve the shape, position or proportion of the ear. Artiste Plastic Surgery's ear reconstruction plastic surgery is a two-step procedure done to recreate a lost ear. The postauricular region is also supplied by the occipital artery. 39(5):472-7. . The helix extends superiorly in a gentle curve. Skin flap surgery uses skin flaps, which are skin and tissue near the wound, to cover the wound. He underwent Mohs surgery for removal followed by reconstruction using a type skin flap called an Antia-Buch flap. Flaps may include cartilage, such as the chondrocutaneous helical advancement flap and the conchal bowl transposition flap for partial helical defects. A skin graft and/or temporoparietal fascia flap is sometimes needed to project the ear. 11. PMID: 5336914 [Indexed for MEDLINE] MeSH terms. Another important reconstruction pearl to maintain the smooth curve of the helix is the use of the Z-plasty to prevent retraction of the wound edge and notching. Forehead flap surgery is used to repair nasal defects. 2011;11(3):1–16. The lower third of the auricle curves at approximately a 45-degree angle as it descends into the earlobe. Concentrically, within the helix is the antihelix, which separates into two separate crura in the upper third of the ear that define the triangular fossa. https://www.csurgeries.com/video/ear-reconstruction-with-postauricular-flap Defects resulting from oncologic resection should consider documentation for clear margins or Mohs excision prior to definitive reconstruction. This study is particularly relevant to staged retroauricular flaps because it appears that flaps up to 5 cm from the external auditory canal would have a sufficient vascular supply. (D) Long-term postoperative result. In April, Dr. Kongkrit Chaiyasate removed cartilage that connects Charlotte Ponce’s ribs to her sternum. The variability in skin graft healing and inosculation may alter how long a dressing is kept in place. Immediately After Ear Surgery. This 80-year-old gentleman underwent total nasal alar reconstruction using a forehead flap, septal flap, and ear cartilage (case # 11559). Unlike the lip, a simple wedge excision may lead to an uneven closure and notching of the helical rim because of the complex topography of the ear cartilaginous framework. Abstract Ear reconstruction can be challenging but also very rewarding due to its complex topography. 1967 May. It may also be done to repair surgical or traumatic scars to improve skin appearance. 9. Though flaps for ear reconstruction don't have named vascular pedicles, it is important to understand the vasculature in order to successfully mobilize these flaps.… It’s quite rare - the majority of plastic surgeons see 1-2 cases per year – but the results are now excellent due to advances in reconstructive surgery. For the most part, the operation is done on children between the ages of four and fourteen. The bridge is divided after the flap has grown new … The posterior auricular artery runs in the sulcus between the auricular cartilage and the mastoid process of the temporal bone. Due to his tumor sites (around the eye and nose), Jon had a preoperative consultation with both his dermatologist and a plastic surgeon. The blood supply to the auricle is through the posterior auricular artery and superficial temporal artery. Continue reading for details on ear surgery recovery. Plast Reconstr Surg 20:1, 1957. Patients who wear glasses should also be educated in postoperative care and management of incisions. The postoperative dressing is as important to a good outcome as securing the graft. Check out our before and after photos here. A postauricular staged flap for reconstruction of the superior helical rim. In the past, it was used to erase cultural identity or create a cookie-cutter version of generic femininity. For defects that involve more than half of the superior portion of the auricle, a prosthesis or referral to a head and neck surgeon may be appropriate. In plastic surgery, a dog ear is a term used to describe a point or fold at the end of a skin-tightening incision. Crikelair GF. Tolleth H: Artistic anatomy, dimensions, and proportions of the external ear. After. The vasculature of the ear. https://www.csurgeries.com/video/ear-reconstruction-with-postauricular-flap Older definitions do not completely describe the term flap in today’s context, as most of these definitions date back to the pre-free-flap era. They conducted a retrospective review of all lateral forearm flap reconstructions performed between … 14.7 and 14.8 ). Proceeding medially from the helical rim is the scaphoid fossa. Flaps may also be “tubed” to rebuild the helical rim from the preauricular or postauricular sulci ( Fig. The outer rim or helix creates the outer curvature of the ear and originates from the face at the root of the helix. (C) The scar that results from harvest of a LAP flap lies along the waistline at the junction of the lower back and buttock where it can be concealed by most clothing and bathing suits. 14.2 ). Learn about the comprehensive cosmetic and reconstructive services offered at UPMC's Department of Plastic Surgery. Opposing the tragus, across the conchal valley, is the antitragus, a linear prominence at the origin of the antihelix. The helix continues its descent uninterrupted to the lobule. Any flap surgery is performed with a specific purpose to achieve goal which are as follows: 1. The postauricular region is desirable because the scar will be hidden and it can heal by second intent or be closed primarily ( Fig. Dividing the auricle into superior middle and inferior regions will help choose the appropriate repair. (A) Post-Mohs micrographic surgery. Postauricular Flap for Ear Reconstruction. As it descends, there is a slight prominence known as the Darwinian tubercle. Background: The temporoparietal fascia flap is frequently used in ear reconstruction. For helical rim defects that do not involve cartilage, a full-thickness skin graft will restore the contour without placing tension on the delicate cartilaginous framework. Dr. Kongkrit Chaiyasate, a plastic surgeon at Beaumont Hospital in Royal Oak, reshaped cartilage from Charlotte Ponce’s ribs to rebuild an ear destroyed in a raccoon attack. A “finger” or banner transposition flap for helical reconstruction. The use of a dental roll to maintain well-distributed pressure may improve graft survivability. Ear reshaping surgery in Houston and Webster, Texas, at Houston Plastic and Reconstructive Surgery is a plastic surgery procedure performed to improve the shape, position or proportion of the ear. It can take the form of a bolster dressing and be stabilized with sutures. Ear surgery, or otoplasty, can reduce or reshape ear deformities or protrusion to improve looks and function. Grabb and Smith's Plastic Surgery. 1967 May. Antia NH, Buch VI. Repair of the auricle can be traced back to India (600 bce ), with subsequent contributions by the Egyptians, Renaissance Italians, 19th-century surgeons, and finally German surgeons such as Diffenbach, who played a major role in refining auricle reconstruction. Mohs Surgery Reconstruction Before and After Photos featuring 13 Orange County Plastic Surgery Patients The auricle should appear within the range of expected shapes, be in close approximation to the scalp, and be symmetrical to the contralateral ear. Converse JM: Reconstruction of the auricle. 1. Pure skin perforator flaps fed only by the dermal subpapillary plexus survived, regardless of the presence of the subdermal plexus. In the lower third of the ear lies the lobule or ear lobe, which does not contain cartilage (. The outline of the ear is apparent early in the fetus at approximately the sixth week. (A) Mohs defect and marking for superior-based finger transposition flap. Learn about the comprehensive cosmetic and reconstructive services offered at UPMC's Department of Plastic Surgery. If you have suffered tissue loss over any area of your body, you may be a candidate for flap surgery. A recent cadaver study demonstrated the robust anastomoses in the mastoid and postauricular space. Since ears tend to grow as we get older. The most important principle of reconstructing the ear is to maintain the natural contour and shape as defined by the helical rim. These grafts can be sewn in with 6-0 absorbable or nonabsorbable sutures. However, it is usually prudent to leave a dressing undisturbed for 1 week. To someone not in the medical field, the term may be unfamiliar. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. Call 1-877-639-9688 to make an appointment. A common donor site for full-thickness skin grafts: the postauricular region. Aston SJ, Beasley RW, Thorne CH, eds. Plastic Surgery Before and After Real Patients 609 page-template-default,page,page-id-609,bridge-core-1.0.5,ajax_fade,page_not_loaded,,qode-title-hidden,qode_grid_1300,qode-theme-ver-10.1.1,wpb-js-composer js-comp-ver-6.0.2,vc_responsive Plast Reconstr Surg. With the increased incidence of skin cancer, these defects have become commonplace. Flaps are pieces of skin that are connected to a major artery or vein. to evaluate the efficacy and reliability of a new axial island retroauricular flap (middle-retroauricular island flap M-RIF) for coverage of non-helical ear defects with direct donor site closure. ... Getting into a M.Ch/ DNB Plastic surgery program is an uphill task considering the competition. For larger defects, flaps may be staged, either from the preauricular or postauricular regions ( Fig. Read "The visor ear flap: a new method for reconstruction of upper helical defects, European Journal of Plastic Surgery" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. (C) Regions of the auricle supplied by these two arteries. The greater auricular nerve, which originates from C 2 and C 3 , extensively innervates the cranial aspect of the ear, including the earlobe. … Random vascular pattern flaps based on the generous and redundant blood supply of the ear have a high survival rate. Respected microsurgeons from around the world describe how to use these flaps to reconstruct particular defects around the body. The result one month after surgery is shown. Read "Nostril reconstruction with ear helix free flap, European Journal of Plastic Surgery" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Ear surgery, also known as otoplasty, can improve the shape, position or proportion of the ear. This bowl-like structure can be divided into the cymba, which is bounded superiorly by the anterior crus of the antihelix and inferiorly by the crus of the helical rim. If there is exposed cartilage, it may be prudent to provide coverage rather than allowing second intent healing. Grabb and Smith's Plastic Surgery. The pure skin perforator flap can be as thin as a skin graft and it has the possibility to reduce the complications that frequently occur when the previously reported p … Plast Reconstr Surg 2010;126:1213-21. Common donor areas include the preauricular and postauricular sulci. Mr Kenton-Smith rarely performs a wedge excision for a lesion on the rim of the ear as this tends to lead to a smaller cupped ear. Venous drainage is via the posterior auricular vein into the external jugular system and the superficial temporal and retromandibular veins. As these two limbs of the antihelix stretch to meet the helical rim, a depression known as the triangular fossa bounded by these two limbs and the rim is created. The authors hypothesized that it is safe and effective for head and neck reconstruction. Ear reconstruction surgery is considered one of the most challenging plastic surgery procedures. Tumor extirpation with Mohs micrographic surgery is the treatment of choice in this area for providing the highest possible cure rate and minimal sacrifice of normal tissue. During surgery, a wound is closed in a linear fashion (meaning the scar is like a line). For full-thickness conchal bowl or antihelix defects, posterior-based flaps may be bivalved to resurface both the lateral and medial side of the defect ( Figs. These techniques range from harvesting costal cartilage buried in the abdomen to using porous polyethylene. A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. Earlobes tend to be asymmetrical and elongate with age. But when skin or tissue is removed, it is in a circular or football shaped incision pattern. Finally, the Arnold nerve, a branch of the vagus (CN 10 ), supplies sensory nerves to the concha. Fu-Chan Wei and Samir Mardini, explains how to achieve excellent results while performing all major conventional and perforator flaps used as both pedicled and free flap procedures. (C) Postauricular flap attached. Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive. Contact Us. Medial-posteriorly, the concha leads to the external auditory canal. Clin Plast Surg 5:337, 1978. Aesthetically, the most important aspect of the earlobe is its independence as a separate cosmetic unit while maintaining the curved continuity of the helical rim. Generally, the auricle protrudes from the scalp at a 20- to 30-degree angle. Dr. Zampell is an extremely approachable and compassionate surgeon who is able to produce elegant and natural looking results at … Because of the robust blood supply, the healing is usually rapid with excellent cosmetic results. This procedure releases the rim of the ear allowing it to be shifted up to fill in the hole. The skin on this side is bound down to a convoluted cartilaginous structure with convex and concave surfaces. Google Scholar Inferior to the crus is the cavum, which has a more concave nature. Jon, 41, had never heard of flap surgery before he went in to receive treatment for two basal cell carcinomas on his face. 1967 May;39(5):472-7. He reshaped the tissue into a roughly C-shaped framework of an ear. Ha RY, Trovato MJ. The addition of two perpendicular Burow triangles will facilitate a wedge excision closure by removing the redundant cartilage. Facial Plast Surg 2020. The lateral forearm flap—a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery—is an attractive alternative to the radial forearm flap. It may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds, and, in rare cases, for improving a … The forehead flap procedure can take months to heal, depending on procedure types and the underlying condition of the patient. P. This 57-year-old man had removal of a basal cell skin cancer and reconstruction with a skin graft, the colour match will improve with time (case # 11570). Flap techniques: The most commonly used technique in post skin cancer facial reconstruction, a flap technique uses a piece of tissue that has a good vascular supply. These three veins flow into the external jugular vein. Puckering at the end of a scar. Flaps and Reconstructive Surgery, by Drs. Aside from the intrinsic rigidity produced by the cartilaginous framework, the auricle is held in placed by small muscles and ligaments. It can correct a defect in the ear structure that is sometimes present at birth or that becomes apparent with child development, or it can treat misshapen ears caused by injury. It is particularly useful in concavities such as the conchal bowl and scaphoid fossa. Postauricular Flap for Ear Reconstruction Matthew M. Hanasono DEFINITION Reconstruction of auricular defects arising from trauma or oncologic resection aims to restore the natural anatomic structures and landmarks of the ear and ideally should maintain balance and symmetry with the contralateral ear. 14.3 ). In general, the donor site is from the ipsilateral side because this will decrease the need for patient repositioning. Plastic Surgery & Reconstruction. Case 11570 Skin Graft to the Nose. Modified Antia-Buch Flap This is a modification of a procedure called an Antia-Buch flap. Earlobe thickness or “fleshiness” also varies from barely discernable from the helical rim to a very defined and separate structure. Retaining the essential curvature of the helical rim is a key element in reconstructing the ear. Part of the best-selling Operative Techniques series, Operative Techniques in Plastic Surgery provides superbly illustrated, authoritative guidance on operative techniques along with a thorough understanding of how to select the best procedure, how to avoid complications and what outcomes to expect. to evaluate the efficacy and reliability of a new axial island retroauricular flap (middle-retroauricular island flap M-RIF) for coverage of non-helical ear defects with direct donor site closure. A common reason for nasal reconstruction is Mohs surgery to … Chondrocutaneous advancement flap for the marginal defect of the ear. The postauricular flap is also known as the retroauricular flap or the Dieffenbach flap. Saint Luke’s Plastic Surgery Specialists is here to educate and guide you in the decision-making process. As such, repair on the lateral surface is usually limited to second intention healing, skin graft, or a flap from the medial pinna or other nearby cosmetic unit (i.e., preauricular cheek or postauricular scalp). Some basic ways of creating flaps are 5: Advancement flap: skin is moved in a straight line; Rotation flap: skin is moved around a pivot point; Interpolated flap: the donor site is separate from the recipient site. The posterior-medial aspect has looser skin and some subcutaneous fat overlying the cartilaginous framework ( Fig. The second stage involves elevating the flat 3D construct of the ear from the ear pocket to create elevation and a post-auricular sulcus. In addition, the patient’s age and comorbidities led the authors to consider the SCIF as a viable option for total ear reconstruction while taking into account the possibility of reconstruction without microsurgery, as well as the color, texture, glabrous skin, and thickness of the flap. The major anterior landmarks of the external ear are the helix, scapha, antihelix, concha, and tragus and antitragus. Explore the fascinating world of cosmetic and plastic surgery with world-renowned double board-certified plastic surgeon Dr. Barry Eppley OR Snapshots – Total Ear Reconstruction with Temporoparietalfascial Flap The blood supply is mainly supplied by the superficial temporal and the posterior auricular arteries. 14.5 ) or from the temporal scalp. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is because a child’s ear cartilage is soft and easy to mould. Venous drainage occurs via corresponding named veins in addition to the retromandibular vein. ‘Flap’ is a term regularly used by Plastic and Reconstructive Surgeons mainly and is a mystery to most patients and doctors alike. When the temporoparietal fascia flap is unavailable, options for primary or secondary salvage reconstruction are limited. It was excised and the area reconstruction with a skin graft. Alternatively, a secure pressure dressing will most likely be as effective as the most complex bolster. Ask a Surgeon has moved to Smart Beauty Guide. American Society of ... DIEP flap: Deep Inferior Epigastric perforator flap which takes tissue from the abdomen. Aston SJ, Beasley RW, Thorne CH, eds. Deformity of the ears may cause … Ear reconstruction can be challenging but also very rewarding due to its complex topography. Laterally, the helix actually begins with the crus, which originates at the superior aspect of the conchal bowl. The skin on the medial surface of the ear … Both procedures will flatten the edges of the flap and provide a smoother, less noticeable transition between the flap … For larger holes the standard Antia-Buch flap releases the rim above the defect as well allowing the upper rim to slide down and the lower rim to slide up. In teenagers and adults, the firmer cartilage of fully formed ears does not allow the same degree of moulding. Earlobe length depends on ethnicity but is approximately 2 cm on average. Postauricular flaps used in ear reconstruction can be based in the superior, middle, or inferior postauricular and mastoid region. Local (Pedicled) Flap: These flaps remain attached to their original vein or artery, though they are adjusted to cover adjacent tissue. Sutures can be placed through the center of the graft to secure it to the underlying tissue to obliterate a potential space for a hematoma or seroma. 5th ed. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. ; Bone grafting: Bone is most often taken from the skull and shaped to be placed into the excision site. Although not as important as the shape, the height of the auricles should be similar. 413-29. Plastic surgery isn’t what is used to be. This is an essential, user-friendly backpack reference for plastic surgery residents to use during rounds and as a board prep. 14.1 ). Adult; Ear Deformities, Acquired/surgery* Humans; Male; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous; Wounds and Injuries/surgery* The superficial temporal artery and its branches, including the direct auricular, supply the anterior (lateral) surface of the ear, particularly the superior half. Advancing local flaps (usually an “Antia-Buch” reconstruction) leads to the best aesthetic result. If the shape, particularly the curve of the helical rim, is not smooth, it will be instantly noticeable. Plast Reconstr Surg. Both are branches of the external carotid. Our facial plastic surgeons are board-certified in both otolaryngology and facial plastic surgery, making them experts in restoring form as well as function. Nasal Reconstruction after Mohs Surgery: What to Expect. The concha lies within the antihelix and is the structure that leads to the external auditory meatus. Posteriorly, there are eminences that correspond to these anterior landmarks. The helix is smooth and retains its original shape. 4. Brent B. Reconstruction of the ear. 10. The coverage will reduce pain, minimize distortion due to wound contraction, and lessen the risk of chondritis. For medium-sized defects of the scaphoid fossa or conchal bowl in which second intent healing may require several weeks, a full-thickness skin graft will minimize wound care and possible chondritis. Turan A, Turkaslan T, Kul Z, et al. Auricular Reconstruction in Hemifacial Microsomia with an Expanded Two-Flap Method. Reconstructive surgery, mainly excision, closure and flap reconstruction, is used to treat a range of cancer conditions, especially cancer of the skin, breast, head and neck and sarcoma. This is commonly used for holes confined to the rim of the ear because it easily fills small to medium sized defects and heals reliably. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). Surgical Treatment of Lymphedema We offer complex, super-microsurgical techniques to help manage and cure lymphedema, a painful condition that may result from surgery for breast cancer surgery . Flap surgery. Following birth, the external auricle grows quickly. Our plastic surgeons are also trained to transplantation to reconstruct wounds when reconstruction is not possible. 1 Flap techniques can also produce excellent results … Because the auricle framework gives the ear its characteristic shape and orientation, until recently little emphasis has been placed on the cutaneous defects of this cosmetic unit.
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