Auricular Reconstruction in Hemifacial Microsomia with an Expanded Two-Flap Method

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Abstract

Background:

Reconstruction of external ear is important for the child/adult with craniofacial deformities to achieve balance and harmony of the face and head. The aim of this study was to investigate the clinical application of an expanded two-flap method for auricular reconstruction in hemifacial microsomia.

Methods:

Between January of 2014 and November of 2015, 111 hemifacial microsomia patients with microtia underwent auricular reconstruction with an expanded two-flap method. The clinical data of these patients were reviewed retrospectively. Thirty-two patients (28.8 percent) underwent auricular reconstruction in combination with simultaneous mandibular lengthening. Microtia was treated by an expanded two-flap method, which includes three stages. In the first stage, the retroauricular skin was expanded using a kidney-shaped tissue expander. In the second stage, the costal cartilage was harvested and the framework was fabricated. The anterior surface of the framework was enveloped by the expanded skin flap. The posterior surface and the helical rim of the framework is covered by a retroauricular fascial flap and a full-thickness skin graft. In the third stage, the tragus was reconstructed, the lobule was formed, and the concha was excavated. The surgical planning and skills of auricular reconstruction—especially for hemifacial microsomia—were described and analyzed. The median duration of follow-up was 8.3 months.

Results:

There were nine cases (8.1 percent) of complications in our study. During follow-up, 103 patients (92.8 percent) had satisfactory outcomes, seven (6.3 percent) had partially satisfactory outcomes, and one patient (0.9 percent) had an unsatisfactory outcome.

Conclusion:

Auricular reconstruction using an expanded two-flap method in hemifacial microsomia is safe and effective, with satisfying middle-term results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

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