Eur J Plast Surg (2003) 26:246 DOI 10.1007/s00238-003-0542-5 INVITED COMMENTAR Y H. S. Byrd Commentary on: “Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia” by Hatoko et al. Published online: 28 August 2003 © Springer-Verlag 2003 The authors should be congratulated for reviewing their The primary aesthetic criteria for auricular reconstruc- experience using ipsilateral conchal cartilage and a pedi- tion in our experience has been the reconstruction of a cled temporoparietal fascial flap in the reconstruction of seamless and well defined helical rim. Unfortunately, conc- ear defects of the superior third less than 2 cm in dimen- hal cartilage almost always falls short of providing the cur- sion. We agree with the authors that the temporoparietal vature and detail necessary to obtain this helical rim con- fascial flap provides reliably vascularized fascia that tour. In defects such as shown in Figure 1 of the manu- readily accepts overlying skin grafts and that conchal script, our preference remains the use of the free floating cartilage will provide a stable skeleton for small auricu- ninth or tenth rib cartilage with the tip of the cartilage di- lar defects without creating deformities to the ear. The rected toward the lobule and we put the thicker proximal authors correctly note the problem of obtaining satisfac- part of the cartilage superiorly so as to match the height of tory color match with grafted skin. Our preference has the helical defect The rounded edge of the rib cartilage been the use of postauricular skin on the anterior surface graft more closely simulates the contour of the missing he- of the ear whenever possible. We make sure and elevate lical rim than what can be achieved with conchal cartilage. the skin adjacent to the defect and allow the temporopa- Our preference for flap coverage of limited defects rietal fascia to span beyond the margin of the actual de- such as shown in the constricted ear deformity continues fect. We believe that this helps to minimize the indenta- to be the use of postauricular flaps or in many instances tion and demarcation between the normal and grafted step expansion of the scapha and helical rim complex portion of the reconstruction. with grafted auricular cartilage placed beneath vasulari- zed anterior and posterior auricular skin and postauricu- lar full thickness skin grafts placed over exposed vascu- larized scaphal cartilage. This combination maintains color match while expanding the auricular framework. This commentary refers to the article which can be found at Admittedly, the auricular cartilage in these instances may http://dx.doi.org/10.1007/s00238-003-0541-6. require additional strength and stabilization through the H. S. Byrd ( ) use of posterior conchal grafts. Department of Plastic & Reconstructive Surgery, Again, the authors should be congratulated and we Children’s Medical Center, hope our comments deepen the readers’ appreciation for Dallas, Texas, 75235, USA e-mail: email@example.com the challenge in these auricular defects.
European Journal of Plastic Surgery – Springer Journals
Published: Sep 1, 2003
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