The Clinical Application Of Auricular Reconstruction With The Postauricular Ultrathin Skin Flap

Objective :discuss the clinical efficacy and security of auricular reconstruction with the postauricular ultrathin skin flap.Methods : In retrospective survey, we analyzed 21 cases of patients who took auricular reconstruction from May. 2014 to May. 2016. There were 16 males and 4 females with 9 left ears reconstruction, 10 right ears reconstruction and one bilateral ears reconstruction. The oldest patient was 32 and the youngest one was 7, with average age 15. During the first stage, we constructed the ear framework with autologous rib cartilage, which was embedded in the post-auricular flap. After one month, the hair on the flap was removed by laser. On the second stage, we fixed the autologous wedged-shape cartilage on the original embedded ear framework to increase the auricular angle. The exposed cartilage was covered by skin graft. On the third stage, we improved subunits of the ear. Results: 20cases(21 ears)have completed auricle reconstruction. There were no completed in 19cases(85%). On the first stage, only one case(5%) was found cartilage exposure. Partial flap necrosis and auricle deformation were found on two patients(10%) respectively. All complications were solved by surgical debridement and repair surgery. No infection and absorption of cartilage framework occurred. All of the constructed ears were satisfied with the results, including good shape and steady auriculocephalic angles. All of cases without remarkable scar hyperplasia. After the follow-up of 6m-12 m, scored the condition of reconstructive ear according to the condition. For the 18 cases,the shape of reconstructive ear verisimilitude, clear structure of subunit, good shape and steady auriculocephalic angles. There was no significant cartilage absorption or retract trend of the reconstructive ear. The color of grafting skin area is close to normal skin and the scar is light. 2cases framework deform, 1 case had cranioauricular angle retraction. The mean score of all cases as followed up for about half a year was 17.45. The mean score of all cases as followed up for about a year was17.9.Conclusions: 1. instead of the fascia flap and free skin graft, postauricular ultrathin skin flap wrapped reconstructed auricle completely. The reconstructed ears have a natural three- dimensional shape and auricular angle. 2. Ear scar hyperplasia is controlled markedly using flap. 3. Without water injection, inpatient time is 2 months shorter. 4. Residual hairs of thin flap are removed by laser for a better apperance.5. It is easier to restore exposed cartilage or skin defect using retained postauricular fascia and superficial temporal fascia.