The combined posterior temporoparietal and galeal fascial flap: a new flap in the elevation of the constructed auricle (second stage of microtia correction).

Over the past few years, the technique of elevating the buried ear framework in the second stage of microtia correction has shifted from skin grafting to the use of flaps and cartilage blocks in the retroauricular sulcus. While the temporoparietal fascial flap should be reserved for secondary procedures and the treatment of complications, the mastoid fascial flap is inadequate by itself and needs an additional cartilage graft. Here, we describe a new flap, the combined posterior temporoparietal and galeal fascial flap, for the elevation of the buried ear cartilage. The flap is robust, with a dependable blood supply based on the posterior branches of the superficial temporal artery. In four cases the flap was rolled up and inset into the retroauricular sulcus, while in three cases an additional conchal cartilage graft was inserted into the roll. All the patients had satisfactory ear projection at follow-up 10-14 months postoperatively. We discuss the surgical technique and the advantages of this flap. We believe that this new flap, which has not been described before, has the potential to replace other flaps in the second stage of microtia correction.     

Refinements of minimal-incision rhytidectomy

Minimal-incision rhytidectomy has achieved increased popularity in recent years and is used successfully to rejuvenate the mid-face and submental regions. A technique of minimal-incision rhytidectomy is presented that eliminates post-auricular scarring and hairline distortion without need for a visible dog ear adjacent to the lobule. All dissection is performed through an incision in the temporal hairline and pre-auricular areas. A multi-vector SMAS plication is performed with the addition of submental liposuction and limited laser resurfacing if necessary. Skin excess is distributed into the temporal hair and a downward rotation flap is utilized to eliminate the resultant dog ear. Representative results are presented utilizing this technique which has become the author's preferred method of facial rejuvenation where limited correction of cervical aging is required. With the exception of more limited correction in the mid and lower cervical areas, results are comparable to traditional methods with a more extensive scar burden. The technique presented is applicable to a wide range of patients and may have special utility in male patients and in tobacco users.     

Question Mark Ear Deformity and a Modified Surgical Correction Method: A Case Report

Question mark ear (Cosman ear) deformity, a rare congenital malformation, is characterized by a cleft between the helix and the ear lobe and marked prominence of the auricles. Although the features of question mark ear deformity are well described in the literature, there is no definitive surgical technique for repair of this deformity, Several surgical methods have been introduced for the correction of the deformity. These techniques mainly provide for repair of the cleft between the helix and ear lobe. However, marked prominence of the upper auricle usually is also present with the cleft. We modified the surgical technique to correct the cleft and the upper prominence at the same time. With this procedure, the cleft is exposed by raising a vertical cutaneous flap based on the cleft on the posterior side of the ear, After anterior scoring to form the antihelix and cleft repair using an ipsilateral conchal cartilage graft, the cutaneous flap is used to cover the cartilage graft and the flap donor site is closed primarily to facilitate restoration of the antihelix. The authors report on a patient with Cosman ear and introduce their modified technique that can be used for repair of the cleft between the helix and ear lobe and the prominence of the upper helix in the same procedure.     

Correction of microtia with construction of the tragus using a chondrocutaneous flap

For microtia correction we have been inserting a cartilage framework and reconstructing the tragus at the first operation in one stage, using part of the microtic ear. This procedure is started with transposition of the lower two-thirds of the microtic ear to make a lobule. The upper third of the microtic ear is elevated as a chondrocutaneous flap which is then transposed downwards to the conchal cavity to make a tragus. The cartilage of the chondrocutaneous flap is anchored, using a bolster to pull it back and outwards. Using this technique, we have reconstructed 34 microtic ears. Adequate positioning of the auricle and tragus has been achieved and a natural auricle obtained even when observed from a frontal oblique direction.     

New Flap for Restoration of the Temporal Hair Line

The authors have devised a novel method of designing a flap for coverage of posttraumatic temporal hairline alopecia. They have successfully performed restoration of temporal hairline alopecia as large as 18 × 4 cm resulting from a previous trauma treated with a primary grafting. The new method uses a simple flap designed preoperatively by Doppler based on the supraorbital vessels up to the flap’s anastomosis with the occipital vessels. This flap is easy to design and elevate with sufficient blood flow. Alopecia resulting from scar formation at the suture line is not conspicuous. The donor site can be closed primarily, and no dog ear has resulted from its application.     

两皮瓣法矫治先天性纵向耳垂裂畸形

目的介绍一种两皮瓣法矫正先天性纵向耳垂裂畸形的方法及其应用效果。方法以耳垂背面组织为蒂，于纵向耳垂裂口的两侧面，分别设计皮瓣，其中内侧耳垂较小的皮瓣去表皮后，插入外侧耳垂皮瓣下缝合固定，外侧耳垂皮瓣完全覆盖内侧去表皮的组织瓣，耳垂裂畸形得到完全矫正。结果本组7例患者，切口均工期愈合，皮瓣全部成活。随访2个月～1．5年，耳垂裂得到完全矫正，外形满意；切口瘢痕不明显；双侧耳垂对称，患侧耳垂较对侧正常耳垂在大小、形态方面，无明显的差异。结论两皮瓣法矫正先天性纵向耳垂裂畸形。方法简单易行，术后效果较好。     

Oncoplastic Technique for the Elimination of the Lateral “Dog Ear” During Mastectomy

Abstract: Following a mastectomy, both the cosmetic and functional results can be impaired by the presence of a lateral “dog ear.” This is a particular problem in women with a large body habitus giving an increased amount of adipose tissue lateral to the breast. The standard approaches to this operation of horizontal or oblique incisions often results in an uncomfortable, unsightly lateral “dog ear”. We describe a modification to the standard mastectomy incision that allows extensive excision of the lateral adipose tissue, re‐draping the skin over the chest wall, thus eliminating the “dog ear.” The mastectomy is performed through two oblique incisions originating in the axillary skin crease encompassing the nipple areolar complex, followed by extensive lateral fat excision. A distance of 2–3 cm is kept between the superior limit of the two incisions. At closure the lateral skin flap is advanced superiomedially on the chest wall without tension. This simple and reproducible technique improves cosmesis and patient satisfaction following modified radical mastectomy by eliminating the lateral “dog ear.”     

软骨划痕及折叠法联合应用矫正Stahl耳畸形

目的：介绍一种St ahl耳畸形矫正的方法。方法：针对一组17例患者,联合应用软骨划痕法及软骨折叠法矫正畸形。结果：16例患者第三对耳轮脚得到完全纠正,1例在耳轮处有较小的异常对耳轮脚的残余。在所有的病例中原较宽的耳舟均被纠正至正常宽度,对耳轮及其上脚的连续性得到较好的保留。所有的患者及其家人对手术的最终效果表示满意,没有手术并发症。结论：软骨划痕法和软骨折叠法联合矫正Stahl畸形简单实用,术后效果满意。     

The V flap: a combination of V-Y advancement and two Limberg transposition flaps

Two annoying problems are encountered in surgical correction of greater defects by flap plasty: the widely undermined cavity seen when using transposition flaps to cover large wound cavities and the necessity to cut away healthy skin because of dog ears or a Burrow's triangle. The V flap is a method of shifting and transposing of the skin surrounding the defect to avoid these troublesome disadvantages. With the exception of cases where a myocutaneous island flap is indicated, this simple V-flap technique yields excellent surgical results.     

Posterior Auricular Muscle Flap as an Adjunct To Otoplasty

Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future.     

Preauricular flap for post burn ear lobe reconstruction - a case report

Burns of the face often affect the ear causing deformation of the pinna or ear lobe due to perichondritis or loss of cartilage and excess scarring. The reconstruction of the ear lobe may be limited due to scarring of the surrounding tissues. We describe a preauricular flap for reconstruction of the anterior and posterior surface of the ear lobe following burn injury. This two stage technique of ear lobe reconstruction by a preauricular flap is not described in the available literature. An inferiorly based preauricular flap was harvested in a young lady who had post burn loss of the right ear lobe. This was folded on itself and sutured to reconstruct both surfaces of the ear lobe. After 6 months, it was released from its attachment at the retromandibular area to define the cheek lobe angle and to shape it. The preauricular flap for ear lobe contouring is a simple and easy technique. An adequate length may be harvested without significant donor site morbidity.     

The correction of lower eyelid retraction with ectropion due to gravity with auricular cartilage —suspension of lower eyelid with cartilage sling

Summary There are many surgical treatments for lower lid ectropion, but very few are effective for lower eyelid retraction with ectropion because of the influence of gravity on the flap transferred to the cheek. In two cases, we have successfully treated lower lid ectropion by suspending the lower lid with the ear cartilage taken from the antihelix. We believe that ear cartilage taken from the antihelix is a suitable material to suspend the lower eyelid for correction of lower eyelid retraction with ectropion due to gravity acting on the flap.     

Urethroplasty using the pedicled island flap technique in complicated urethral strictures

Many techniques have been described for the repair of recurrent urethral strictures. Experience with 1-stage correction of hypospadias and epispadias, using a vascularized island flap technique, has led to its increased application for complicated adult urethral strictures. The advantage of the vascularized island flap technique is that reconstruction can be completed with only 1 operation, and it provides good subjective and objective results. Analysis of 50 consecutive cases treated by this approach has proved its validity. Of the 50 cases fistulas occurred in 20%, of which 12% required surgical correction, and stricture recurred in 32%. The largest proportion of recurrence was noted in patients who were primarily treated with 3 or more urethrotomies within a short time. Therefore, we recommend open surgical repair when 1 or 2 internal urethrotomies fail to produce a good result.     

Two-Lobed Advancement Flap for Cutaneous Helical Rim Defects

BACKGROUND: Bilobed flaps, transposition repairs used primarily on the nose, recruit tissue from an area of laxity via rotational motion. A variant of the bilobe, the two-lobed flap based on the W-plasty, is a transposition flap that shifts tissue predominantly via advancement. OBJECTIVE: To apply the two-lobed advancement flap to the problem of reconstructing cutaneous helical rim defects of the ear. METHODS: Helical two-lobed advancement flaps were designed and implemented to correct small- to medium-sized defects. RESULTS: The ear helix was successfully repaired with two-lobed advancement flaps. There was minimal distortion of the ear architecture or cartilage, and blood supply was sufficient to ensure flap viability. CONCLUSIONS: In selected cases, cutaneous helical rim defects of the ear can be aesthetically repaired with a two-lobed advancement flap derived from the posterior auricular surface.     

Reading Man Flap: Application to Plantar Defects

The plantar surface of the foot has highly specialized, densely adherent, glabrous skin, making functional replacement difficult. Glabrous skin defects should be replaced with similar skin to restore function and aesthetics. An innovative technique, the “reading man flap,” was developed for closure of circular skin defects. At locations such as the face, trunk, thigh, and calf, the “reading man” procedure provides tension-free closure with minimal additional healthy skin excision, and it does not cause “dog ear” formation. The potential exists for replacement of plantar defects with skin of the same quality using this procedure. In the present study, we report on 2 clinical cases in which intermediate-size plantar defects were reconstructed using the reading man flap. This method can provide tissue as durable, yet as sensitive, as skin that matches the unique characteristics of the plantar skin.     

A modification of technique to cover a large posterior thigh defect using an anterolateral thigh flap

Anterolateral thigh (ALT) flap is one of the popular flaps for soft-tissue reconstruction. It is a versatile flap which commonly used to resurface external skin defect and internal mucosal lining. In addition if raised as musculocutaneous flap, the muscle portion provides bulk to fill up any potential space. With increase knowledge on the vascular anatomy of this flap, it is possible to harvest 2 skin paddles base on more than one branches of the supplying vessel. This technique is commonly employed to provide coverage of more than one epithelial surfaces such as the complex facial defect after maxillectomy where both the cheek skin and oral mucosa reconstruction are required. Using similar concept, we report a case in which a large external skin defect was successfully covered with an ALT flap and the donor site could be closed primarily without skin grafting.     

"Chinese hat" flap]

A design of a new type of advancement flap is described and called "chinese hat" flap. It uses the properties of the traditional advancement flap combined with rotation at the two distal edges, that overlap the height of the defect like two claws. This allows direct suture for larger defects with a prominent dog ear that become level with time. Two cases illustrate the procedure.     

Transposition technique for correction of a malpositioned nipple-areola complex after reconstruction following a nipple-sparing mastectomy: a case report

We developed a novel transposition technique for the correction of an asymmetric nipple-areola complex (NAC) due to breast mound reconstruction after a nipple-sparing mastectomy. The technique was composed of a rotation flap and an advancement flap. In this study, we describe a case of a 35-year-old woman with a malpositioned NAC located at the upper lateral position with a vertical scar in the lateral area of the breast treated by this technique, with a follow-up period of 12 years. In this case, established techniques were difficult to apply as there were thin underlying subcutaneous tissue and scars near the NAC. This technique may be useful in such a case and is an additional option in the correction of a malpositioned NAC from the upper lateral position to the ideal position on a breast mound.     

Accordion flap

The accordion flap is proposed as a means of covering a rhombic defect. A prominent feature of the method presented is in the preparation of a flap on one side of the skin defect, resulting in little dog ear.