A New Approach for the Correction of Prominent Ear Deformity: The Distally Based Perichondrio-Adipo-Dermal Flap Technique.

BACKGROUND: Otoplasty techniques are generally divided into 2 categories as cartilage-cutting and cartilage-sparing. The cartilage-cutting techniques have been criticized because of their high risk of hematoma, skin necrosis, and ear deformity. As a result, suture-based cartilage-sparing methods like Mustardé and Furnas-type suture techniques have become increasingly popular. However, with these techniques postauricular suture extrusion may be seen and recurrence rates of up to 25% have been reported. METHODS: In this study, cartilage-sparing otoplasty is redefined by introduction of the distally based perichondrio-adipo-dermal flap which is elevated from the postauricular region. Thirty-seven ears (17 bilateral and 3 unilateral) in 20 patients (14 females and 6 males) have been operated with the defined technique by the same surgeon. The distally based perichondrio-adipo-dermal flap is advanced posteriorly to correct the deformity, also acting as a strong postauricular support to prevent recurrence. In addition to the resultant natural-looking antihelical fold, the posterior advancement of the flap corrects both the otherwise wide conchoscaphal and conchomastoid angles. The operative technique is explained in detail with results and the literature is reviewed. RESULTS: There were no hematomas. After an average follow-up of 8.3 months (2-16 months), recurrence was seen in only 1 patient who requested no further surgery. No patients developed suture extrusion or granuloma. CONCLUSION: The authors introduce a simple and safe procedure to correct prominent ears with benefits including a resultant natural-looking antihelical fold and less tissue trauma. The distally based perichondrio-adipo-dermal flap seems to prevent suture extrusion and may also help to reduce recurrence rates. By forming neochondrogenesis which is stimulated by elevation of the perichondrium, this flap gives the promise of longer durability of the newly formed antihelical fold.

Effect of a fascial tissue interface on silicone implant capsule formation--a preliminary experimental study.

The effects of a fascial tissue interface on silicone implant capsule formation were studied in a rabbit model. In two experimental groups, the thoracodorsal fascia was harvested either as a free graft (Group Ia) or as a fascial flap (Group Ib), then wrapped around silicone implants prior to subcutaneous placement. In each instance the fascia was configured to form a biological interface between the implant and surrounding soft tissue. The resulting capsules were macroscopically and histologically compared to a control group (Group II) of unwrapped silicone implants which were inserted subcutaneously. The cellular response to textured and smooth surfaces on opposing sides of each implant was also separately investigated in both study groups. Statistical analysis was performed using a Student's t-test. The capsules formed in each experimental group were observed to be thinner and less cellular when compared to the unwrapped control group (P<0.05), while no demonstrable differences between fascial flap and free graft subgroups were found (P>0.05). Furthermore, less cellularity and reduced capsule thickness were observed in the textured implant capsule surfaces in both fascial flap and free graft groups when compared to smooth implant capsule surfaces (P<0.05). Our preliminary study findings using a fascial tissue interface, either as a flap or a free graft, reveal cellular architectural characteristics of the resulting capsule that may be significant in minimising capsular contraction around silicone implants.

Versatility of botulinum toxin: a use in stabilization of pedicled muscle flaps.

BACKGROUND: In this study, botulinum toxin A was used to secure the stabilization of muscle flaps without denervation atrophy. METHODS: Thirty adult female Wistar rats were divided into a control group (group I, n = 10), a denervation group (group II, n = 10), and a botulinum toxin A group (group III, n = 10). In all of the groups, pedicled pectoralis major muscle flaps were elevated from the sternal attachment on the right side. In the second group, muscle flaps were denervated by transsecting the pectoralis major nerve after flap elevation; in the third group, botulinum toxin A (1.4 U of Dysport; Ipsen, Maidenhead, United Kingdom) was injected into the prepared muscle flap before flap replacement. The distance between the medial side of the muscle and the midline was measured at 4 weeks. Histopathological examination was performed 10 weeks after the first operation. The diameter of the muscle fibers was measured, and the degree of atrophy in the muscle flaps was evaluated in all groups. RESULTS: Mean distances from the midline were statistically significantly different in all of the groups (p = 0.000, p < 0.01). There was a significant difference in muscle fiber diameter among the groups (p = 0.000, p < 0.01). Temporary denervation by botulinum toxin A and irreversible denervation with transsection of the motor nerve caused the reduced diameters of the muscle fibers. In addition, moderate to severe muscle atrophy in group II and mild to moderate muscle atrophy in group III were observed. CONCLUSIONS: In the pedicled muscle flaps, botulinum toxin A can be used easily and reliably for stabilization. It was concluded that detachment of the muscle flap might be prevented and operative morbidity decreased using this method.