Surgical Reconstruction of Traumatic Partial Ear Defects Based on a Novel Classification of Defect Sizes and Surrounding Skin Conditions.

BACKGROUND: Although a standard classification system and corresponding reconstruction methods are well described for microtia, establishing a classification system and corresponding surgical strategies for traumatic ear defects is difficult because the size, shape, and local skin conditions of each defect differ considerably. In this article, the authors describe a useful new classification system and corresponding surgical approaches. METHODS: Ear defects were classified into four types according to defect size and surrounding skin conditions. Defects in which the postauricular skin is of good quality are classified as types I, II, and III. The rest are type IV defects. Four ears (type I defects) were reconstructed using conchal cartilage and posterior auricular flaps. In 51 ears, costal cartilage and posterior auricular flaps were used for single-stage (type II defects, n = 31) or two-stage (type III defects, n = 20) reconstructions. In five instances of severe posterior auricular cutaneous scarring (type IV defects), temporoparietal fascial flaps were created to cover costal cartilage frameworks. RESULTS: Sixty subjects with traumatic partial ear defects were followed for 6 months to 6 years. Most (n = 55) were satisfied with their results. Two patients complained of an unnatural junction between the graft framework and residual ear stump. One was dissatisfied with the reduced ear size, caused by improper fixation and skin flap contraction. Another developed minor framework exposure because of skin necrosis, which healed with conservative management. CONCLUSION: Using our new classification system for partial traumatic ear defects based on defect size and contiguous skin condition, the corresponding surgical repair approach was applied consistently, yielding acceptable results and few complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[The Antia-Buch flap technique in reconstruction of marginal ear defects]. / Le lambeau d'Antia-Buch dans la reconstruction des pertes de substance partielles de l'hélix.

INTRODUCTION: The aim of this study was to evaluate the results of ear defect reconstruction using the Antia-Buch flap technique and to compare it to other techniques described in international literature. MATERIALS AND METHODS: We performed 19 Antia-Buch flaps between November 1998 and November 2002: 15 cases after neoplastic treatment and four post-traumatic cases. Defect ranged between 15 and 40 mm. Between 30 and 40 mm, we used Fata's modification. The final assessment took into account patient satisfaction, cosmetic aspect of reconstruction assessed by the medical team, the presence of a notch at the helical rim and the degree of microtia. RESULTS: All ear reconstructions were successful. No complications were reported. Fata's modification was used for eight patients. All the patients were satisfied with the result in spite of a systematic microtia. The cosmetic aspect was considered as good for 16 patients, average for three. Nine patients presented with a notch at the helical rim. DISCUSSION: Reconstruction using the Antia-Buch flap is a simple and fast operative technique performed in a single operation under local anesthesia. It allows for a harmonious reconstruction of the helix and auricle with a tissue of same nature, and only a tiny cicatricial ransom, systematic microtia and frequent notch on the helical rim.

[Classification of auricle floor abnormalities in 1st and 2nd branchial arches syndromes]. / Klassifikatsiia porokov i anomalii ushnoi rakoviny pri sindromakh 1-i i 2-i zhabernykh dug.

1000 cases of the 1st and 2nd branchial arches syndrome and abnormalities of the floor of the auricle associated with this syndrome provided evidence for design of their classification. The classification distinguishes severe malformations of the floor of the auricle, malformations with tissue defect, deformations of the floor of the auricle itself.