A Practical Approach in Auricular Surgery Double Helical Rim Advancement Flaps with Scaphal Resection

OpenAlex İngilizce

Sir: Auricular surgery is one of the most demanding procedures in the field of plastic surgery, as the external contours of the ear cannot be mimicked easily. Various techniques have been developed to address a diverse array of problems. The method described here is an easy and practical technique that can be used for ear reduction, reconstruction of helical rim defects, and correction of size discrepancies of ears. In cases of helical tumor surgery, the lesion is excised with safe excision margins; whereas in macrotia and asymmetry, the amount and location of full-thickness resection at the helical rim are planned according to the desired reduction in height or width. This is followed by an incision that transects all the layers of the ear and is continued along the helical sulcus inferiorly and superiorly to yield two advancement flaps. A crescent from the scapha is excised using scissors through the full thickness of the ear (Fig. 1). This resection will facilitate approximation of helical rims without distortion of the ear and will prevent cupping. Finally, the flaps are approximated and sutured to the scapha by means of stitches that pass through skin and cartilage (Fig. 2).Fig. 1.: Double helical rim advancement flaps are mobilized and a crescent-shaped cartilage from the scapha is excised.Fig. 2.: Immediate postoperative view of the patient with the flaps sutured to the scapha.The methods described in the literature for macrotia are rare, and most of them are modifications of chondrocutaneous advancement flaps in which postauricular skin is preserved for nourishment of the helix.1–3 The extensive dissection of skin results in a high risk of hematoma and infection, and causes prolonged edema. Cadaver studies by Park et al. revealed that the auricle has a well-developed vascular system with perforators and subbranches.4 Thus, helical flaps with minimal or no bridge of postauricular or anteroauricular skin can be elevated safely, eliminating the need for preserving postauricular skin. Acquired helical rim defects that stem from trauma, burns, and tumor excision are also concerns of this technique. Among various methods Calhoun et al. practiced a technique of superiorly and inferiorly based helical rim flaps in which a Burow triangle is excised from the upper pole of the ear and a few millimeters of scaphal cartilage is shaved.5 The technique described here also uses double helical rim flaps but with the addition of a full-thickness crescent-shaped resection from the scapha. After tumor resection and reconstruction, the contralateral ear can be reduced with this technique to match the operated ear. The double helical rim advancement flap with scaphal resection is a simple and safe operation that has many advantages. First, the scar in the helical sulcus remains hidden in an anatomical boundary line. Wound closure tension is low and evenly distributed in all dimensions of the ear, which yields a narrow linear scar.4 Second, cupping deformity is markedly eliminated by scaphal excision. As a result of no undermining of posterior and anterior skin, possible occurrence of hematoma, infection, and prolonged edema is avoided. Finally, it is a versatile procedure in terms of restoration of symmetry and contour that can be used for ear reduction and helical rim reconstruction. Erdem Tezel, M.D. Nurdan Ozturk, M.D. Marmara University Faculty of Medicine Department of Plastic and Reconstructive Surgery Istanbul, Turkey