Composite Cartilage Grafting

Postauricular Advancement Flap

Composite Graft Incorporation

Partial Reconstruction of the Auricle – A New One-Stage Technique

Paula Campelo1, MD; Diogo Oliveira Carmo1,2, MD; Margarida Branco1, MD; Catarina Tinoco1, MD; Cristina Caroça1,2, MD; João Paço1,2, MD, PhD

1 Hospital CUF Infante Santo, Lisbon, Portugal; 2 Nova Medical School, Lisbon, Portugal

INTRODUCTION

Figure 1. Surgical planning: (A) avulsion of the upper third of the right ear (B) composite graft harvested from the contralateral conchal to

reconstruct the lateral wall of the auricle; postauricular advancement flap creation to reconstruct the medial aspect of the ear.

ABSTRACT

CASE REPORT

CONCLUSIONS REFERENCES

CONTACT

Introduction: Auricular reconstruction after traumatic ear loss remains a challenge in Otolaryngology and Facial Plastic Surgery. The variety of techniques described in literature shows the intrinsic difficulty of reconstructing a structure with such a delicate architecture. Most of the procedures require a reconstruction in two stages. In this work we propose a new single-stage reconstructive technique of a partially avulsed ear. Methods: We present a case of a 23-year-old male individual, victim of aggression, who sustained a human bite that resulted in the avulsion of the upper third of the right ear, without preservation of the amputated portion. Three months after the injury, the patient underwent reconstructive surgery. The reconstruction of the lateral wall of the auricle was achieved with a composite graft from contralateral auricular concha. A postauricular advancement flap provided the skin to cover the medial aspect of the ear defect. Results: Two months after surgery, a favorable cosmetic result was obtained, with patient satisfaction. Conclusions: This technique gives a good cosmetic result in a single-stage procedure, keeping the symmetry between the ears and the delicate architecture of the ear cartilage.

23 year–old ♂

Caucasian

No previous medical history

Aggression victim (one month before first

appointment): sustained a human bite, resulting in

the avulsion of the upper third of the right ear,

without preservation of the amputated portion

(Figure 1A).

Three months after the aggression, the patient was

proposed and submitted to reconstructive surgery

(Figure 1B) . The reconstruction of the lateral wall of

the auricle was achieved with a composite graft from

contralateral auricular concha. A postauricular

advancement flap provided the skin to cover the

medial aspect of the ear defect (figure 2-4).

Favorable aesthetic results

Single-stage technique

Achieved symmetry between the ears

(orientation, size and form)

Retroauricular sulcus preservation

To Think and Plan…

… each case of auricular reconstruction is unique!

1. Weerda H. Trauma and Non-inflammatory Processes. In: Weerda H, (Ed.) Surgery of the Auricle - Tumors-Trauma-Defects-Abnormalities. Stuttgard: Thieme; 2007. p. 24–41.

2. Magritz R, Siegert R. Reconstruction of the Avulsed Auricle after Trauma. Otolaryngol Clin North Am. 2013;46:841–55.

3. Siegert R, Magritz R. Reconstruction of the auricle. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007;6:Doc02.

4. Kontis TC, Papel ID. Reconstruction of congenital and acquired auricular scaphal deficiencies. Archives of facial plastic surgery : official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies. 2003. p. 263–6.

Paula Campelo Hospital CUF Infante Santo Email: paula.campelo@jmellosaude.pt Phone: +351 919691315

RECONSTRUTIVE SURGERY ǁ STEP-BY-STEP

3 m

on

th -

Po

sto

pe

rati

ve

RESULTS

A B C D E

Figure 2. Composite cartilage grafting. (A) Defect measuring (B) Outlined composite concha cartilage graft harvested from postauricular sulcus of the contralateral ear (C) local anesthesia infiltration (D) Composite cartilage graft (E) Applied bolster to the conchal bowl

F G H I J

Figure 3. Reconstruction of the medial wall of the defect with a postauricular advancement flap. (F) Defect (G) Outlined flap design with large Burow’s triangles (H) Elevated flap and scar tissue removal (I) Flap fixation with surgical staples and neo-retroauricular sulcus creation (J) Simple suture between flap and auricular medial wall

K L M N O P

Figure 4. Composite graft incorporation. (K) Defect (L) Composite graft shaped to fit the defect (M) simple suture between graft and auricle lateral wall (N) Simple suture between graft and flap (O) Applied bolster (P) Situation at the end of surgery.

Auricular reconstruction after traumatic ear loss

presents a challenge to the reconstructive surgeon.

In order to preserve the complex and fragile

anatomy of this structure, as well as the desirable

symmetry between the two ears, it is required a

special care in planning and carrying out the

techniques available to correct it.

Several reconstructive techniques are described in

the literature. In essence, most of them require a

two-step procedure. The size and location of injury

will influence the selection of the most appropriate

surgical procedure.

In this paper we present a reconstruction technique

for defects of the peripheral upper third of the ear,

performed in a single-stage procedure.

Pre

op

era

tive

def

ect

A B

A B

C

D E

F

Figure 5. Preoperative (A) frontal, (B) back and (C) lateral view of auricular defect. Three-month postoperative results (D) frontal, (E) back and (F) lateral.