Reconstruction of Atypical Tragus in Patients with Accessory Tragus or Macrotragus

PURPOSE: Tragus is one of the key structure of the normal shape of auricle. We experienced several cases of hypoplastic tragus with preauricular appendage. This article describes the methods of reconstruction of atypical tragus using accessory tragus or macrotragus to make better aesthetic results rather than simple excision. METHODS: From April, 2004 to March, 2009, 21 patients got operations by our method. Seven patients had bilateral deformity of tragus. Mean age was 12.7 years. For 17 cases of accessory tragus, simple excision, z-plasty and interpolation flap was performed. For 11 cases of macrotragus, debulking and z-plasty was performed. Mean follow-up period was 9.4 months. RESULTS: Reconstructed tragus looked symmetric with the opposite side in contour, size, direction and partial coverage of auditory meatus. There was no enlargement of remnant appendage for the follow up period and there was no complication such as hematoma, infection and chondritis. CONCLUSION: In cases of small and deformed tragus, preauricular tissue such as accessory tragus and macrotragus could be a good source of tragal reconstruction.

Usefulness of Full-thickness Skin Graft from Anterolateral Chest wall in the Reconstruction of Facial Defects

PURPOSE: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. METHODS: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. RESULTS: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. CONCLUSION: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.