Composite Cartilage Grafting Postauricular Advancement Flap Composite Graft Incorporation Partial Reconstruction of the Auricle – A New One-Stage Technique Paula Campelo 1 , MD; Diogo Oliveira Carmo 1,2 , MD; Margarida Branco 1 , MD; Catarina Tinoco 1 , MD; Cristina Caroça 1,2 , MD; João Paço 1,2 , MD, PhD 1 Hospital CUF Infante Santo, Lisbon, Portugal; 2 Nova Medical School, Lisbon, Portugal INTRODUCTION Figure 1. Surgical planning: (A) avulsion of the upper third of the right ear (B) composite graft harvested from the contralateral conchal to reconstruct the lateral wall of the auricle; postauricular advancement flap creation to reconstruct the medial aspect of the ear. ABSTRACT CASE REPORT CONCLUSIONS REFERENCES CONTACT Introduction: Auricular reconstruction after traumatic ear loss remains a challenge in Otolaryngology and Facial Plastic Surgery. The variety of techniques described in literature shows the intrinsic difficulty of reconstructing a structure with such a delicate architecture. Most of the procedures require a reconstruction in two stages. In this work we propose a new single-stage reconstructive technique of a partially avulsed ear. Methods: We present a case of a 23- year-old male individual, victim of aggression, who sustained a human bite that resulted in the avulsion of the upper third of the right ear, without preservation of the amputated portion. Three months after the injury, the patient underwent reconstructive surgery. The reconstruction of the lateral wall of the auricle was achieved with a composite graft from contralateral auricular concha. A postauricular advancement flap provided the skin to cover the medial aspect of the ear defect. Results: Two months after surgery, a favorable cosmetic result was obtained, with patient satisfaction. Conclusions: This technique gives a good cosmetic result in a single-stage procedure, keeping the symmetry between the ears and the delicate architecture of the ear cartilage. 23 year–old ♂ Caucasian No previous medical history Aggression victim (one month before first appointment): sustained a human bite, resulting in the avulsion of the upper third of the right ear, without preservation of the amputated portion (Figure 1A). Three months after the aggression, the patient was proposed and submitted to reconstructive surgery (Figure 1B) . The reconstruction of the lateral wall of the auricle was achieved with a composite graft from contralateral auricular concha. A postauricular advancement flap provided the skin to cover the medial aspect of the ear defect (figure 2-4). Favorable aesthetic results Single-stage technique Achieved symmetry between the ears (orientation, size and form) Retroauricular sulcus preservation To Think and Plan… … each case of auricular reconstruction is unique! 1. Weerda H. Trauma and Non-inflammatory Processes. In: Weerda H, (Ed.) Surgery of the Auricle - Tumors- Trauma-Defects-Abnormalities. Stuttgard: Thieme; 2007. p. 24–41. 2. Magritz R, Siegert R. Reconstruction of the Avulsed Auricle after Trauma. Otolaryngol Clin North Am. 2013;46:841–55. 3. Siegert R, Magritz R. Reconstruction of the auricle. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007;6:Doc02. 4. Kontis TC, Papel ID. Reconstruction of congenital and acquired auricular scaphal deficiencies. Archives of facial plastic surgery : official publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies. 2003. p. 263–6. Paula Campelo Hospital CUF Infante Santo Email: [email protected] Phone: +351 919691315 RECONSTRUTIVE SURGERY ǁ STEP-BY-STEP 3 month - Postoperative RESULTS A B C D E Figure 2. Composite cartilage grafting. (A) Defect measuring (B) Outlined composite concha cartilage graft harvested from postauricular sulcus of the contralateral ear (C) local anesthesia infiltration (D) Composite cartilage graft (E) Applied bolster to the conchal bowl F G H I J Figure 3. Reconstruction of the medial wall of the defect with a postauricular advancement flap. (F) Defect (G) Outlined flap design with large Burow’s triangles (H) Elevated flap and scar tissue removal (I) Flap fixation with surgical staples and neo-retroauricular sulcus creation (J) Simple suture between flap and auricular medial wall K L M N O P Figure 4. Composite graft incorporation. (K) Defect (L) Composite graft shaped to fit the defect (M) simple suture between graft and auricle lateral wall (N) Simple suture between graft and flap (O) Applied bolster (P) Situation at the end of surgery. Auricular reconstruction after traumatic ear loss presents a challenge to the reconstructive surgeon. In order to preserve the complex and fragile anatomy of this structure, as well as the desirable symmetry between the two ears, it is required a special care in planning and carrying out the techniques available to correct it. Several reconstructive techniques are described in the literature. In essence, most of them require a two-step procedure. The size and location of injury will influence the selection of the most appropriate surgical procedure. In this paper we present a reconstruction technique for defects of the peripheral upper third of the ear, performed in a single-stage procedure. Preoperative defect A B A B C D E F Figure 5. Preoperative (A) frontal, (B) back and (C) lateral view of auricular defect. Three-month postoperative results (D) frontal, (E) back and (F) lateral.