The Effectiveness of Posturicular Fascial Flap as an Adjunct to Suture Otoplasty
https://doi.org/10.24017/science.2016.1.1.4
Abstract views: 1049 / PDF downloads: 853Abstract
Mustardé technique of otoplasty is probably the most famous and practical among all otoplasty procedures especially in our centers. Yet it possesses the risk of suture extrusion, stitch granulomas and recurrence. Such complications have been reported, albeit few, yet they are bothersome to patients and their families. Placing tissues between the suture lines and the postauricular incision whether grafts or fascial flaps have been reported to reduce these complications.This study was set to evaluate the effectiveness of elevating a post-auricular fascial flap to cover the sutures in Mustardé and Furnas techniques for reducing the risk of suture extrusion and granulomas and possibly recurrence.Eleven patients with prominent ears (21 ears) fit our inclusion criteria. Nine of them were males and two females. They underwent suture otoplasty with post-auricular fascial flap in Burn and Plastic Surgery Hospital in Sulaimania from December 2011 to July 2015. Their mean age was 15.5 years, with a mean follow-up period of 242 days (ranged from 66 days to 431 days. Polydioxanone suture was used in (6 ears), and polypropylene suture was used in (15 ears).We achieved 91% satisfaction rates among patients and their families (only one patient was unsatisfied). One patient developed partial recurrence of the middle half of antihelix in one side (4.7%). Another one developed bleeding that only needed pressure and change dressing in the left ear (4.7%). Adding fascial flap to cover the sutures appears to be beneficial in preventing suture extrusions and granulomas and possibly recurrence by acting as another supporting layer.
Keywords:
Mustardé otoplasty, Concho-mastoid sutures, Suture extrusion, Stitch granulomas and Recurrence
References
[1] Firmin F, Sanger C, and O'Toole G (2008). Ear reconstruction following severe complications of otoplasty. J Plast Reconstr Aesthe Surg. 61: S13-20. Yugueroes P. and Friedland J A (2001). Otoplasty; the Experience of 100 Consecutive Patients. Plast Reconstr Surg. 108(4): 1045-51.
https://doi.org/10.1016/j.bjps.2008.06.017
[2] Janis J E, Rohrich R J, Gutowski K A (2005). Otoplasty. Plast Reconstr Surg. 115(4):60e-72e. San Martín RE, et al. Otoplasty (2011). Results After Anterior Versus Posterior Approach. ActaOtorrinolaringol Esp. 62(3):188-93.
https://doi.org/10.1097/01.PRS.0000156218.93855.C9
[3] Tan S T and Gault D T (1994). When do ears become prominent? Br J of Plast Surg. 47, 573-4.
https://doi.org/10.1016/0007-1226(94)90143-0
[4] Cortes W and Gosain AK (2009). Prominent ears, in: Guyuron B, editor. Plastic surgery; indications and practice. 1st edition. Saunders Elsevier. Vol.1 p.701-716.
https://doi.org/10.1016/B978-1-4160-4081-1.50057-6
[5] Songu M and Adibelli H (2010). Otoplasty in children younger than 5 years of age. International Journal of Pediatric Otorhinolaryngology. (74) p.292-296.
https://doi.org/10.1016/j.ijporl.2009.12.010
[6] Bradbury E, Hewison J, Timmons M (1992). Psychological and social outcome of prominent ear correction in children. Br J Plast Surg. 45:97-100.
https://doi.org/10.1016/0007-1226(92)90165-T
[7] Cooper-Hobson G and Jaffe W (2009). The benefits of otoplasty for children: Further evidence to satisfy the modern NHS. J Plast Reconstr Aesthe Surg. 62, 190-194.
https://doi.org/10.1016/j.bjps.2007.09.020
[8] Adamson PC, Doud Galli S K and Chen T (2010). Otoplasty, in: Flint PW, et al. (eds) Otolaryngology: head and neck surgery. 5th edition. Philadelphia: Mosby (Elsevier). 1134I.
https://doi.org/10.1016/B978-0-323-05283-2.00034-3
[9] Converse J M and Wood-Smith D (1963). Technical details in the surgical correction of the lop ear deformity. Plast. Reconstr. Surg. 31: 118-128.
https://doi.org/10.1097/00006534-196302000-00002
[10] Mustardé JC (1963). The correction of prominent ears using simple mattress sutures. Br J Plast Surg 16:170-8.
https://doi.org/10.1016/S0007-1226(63)80100-9
[11] Mustardé J C (1967). The treatment of prominent ears by buried mattress sutures; a ten year survey. Plast. Reconstr. Surg.37:382-6.
https://doi.org/10.1097/00006534-196704000-00008
[12] Gibson, T., and Davis, W. B (1958). The distortion of autogenous cartilage graft: Its cause and prevention. Br. J.Plast. Surg.10: 257.
https://doi.org/10.1016/S0007-1226(57)80042-3
[13] Chongchet V (1963). A method of antihelix reconstruction. Br J Plas Surg.16:268-72
https://doi.org/10.1016/S0007-1226(63)80120-4
[14] Stenstrom S (1963). A natural technique for correction of congenitally prominent ears. Plast. Reconstr. Surg. 32:509-18.
https://doi.org/10.1097/00006534-196311000-00003
[15] Furnas, D. W (1968). Correction of prominent ears by conchamastoid sutures. Plast. Reconstr. Surg.42:189.
https://doi.org/10.1097/00006534-196809000-00001
[16] Kurozumi N, Ono S, Ishida H (1982). Nonsurgical correction of a congenital lop ear deformity by splinting with Reston Foam. Br J Plast Surg.35:181-2.
https://doi.org/10.1016/0007-1226(82)90160-6
[17] Yotsuyanagi T, Yokoi K, Urushidate S, et al 1998). Nonsurgical correction of congenital auricular deformities in children older than early Neonates. Plast Reconstr Surg (101:907-14.
https://doi.org/10.1097/00006534-199804040-00004
[18] Gosain AK, Recinos RF (2003). A novel approach to correction of the prominent lobule during otoplasty. Plast Reconstr Surg.112 (2):575-83.
https://doi.org/10.1097/01.PRS.0000071000.80092.2A
[19] Horlock N, Misra A, Gault DT (2001). The postauricular fascial flap as an adjunct to Mustarde' and Furnas type otoplasty. Plast Reconstr Surg. 108:1487-90.
https://doi.org/10.1097/00006534-200111000-00005
[20] Shokrollahi K, Cooper MA, Hiew LY (2009). A new strategy for otoplasty. J Plast Reconstr Aesthet Surg. 62(6):774-81.
https://doi.org/10.1016/j.bjps.2008.03.018
[21] Park C and Roh TS (2002). Anatomy and embryology of the external ear and their clinical correlation. Clin Plastic Surg . 29: 155- 174.
https://doi.org/10.1016/S0094-1298(01)00008-6
[22] Park C, Lineaweaver WC, Rumly TO, et al (1992). Arterial supply of the anterior ear. Plast Reconstr Surg. 90:38-44.
https://doi.org/10.1097/00006534-199207000-00005
[23] Nathan N et al. Otoplasty (2002). In Facial plastic and reconstructive surgery. Ira D Papel (Editors) 2nd Ed. Thieme Medical Publishers. p 309.
[24] Adamson J E, Horton C E, and Crawford H H (1965). The growth pattern of the external ear. Plast. Reconstr. Surg. 36: 466.
https://doi.org/10.1097/00006534-196510000-00008
[25] Janz B, Cole P, Hollier L and Stal S (2009). Treatment of Prominent and Constricted Ear Anomalies. Plast Reconstr Surg.124; p 27e-37e.
https://doi.org/10.1097/PRS.0b013e3181aa0e9d
[26] Matsuo K, Hirose T, Tomono T, et al (1984). Nonsurgical correction of auricular deformities in the early neonate: a preliminary report. Plast Reconstr Surg. 73:38-50.
https://doi.org/10.1097/00006534-198401000-00009
[27] Gosain AK, Kumar A, Huang G (2004). Prominent ears in children younger than 4 years of age: what is the appropriate timing for otoplasty? Plast Reconstr Surg. I l4 (5):1042-1054.
https://doi.org/10.1097/01.PRS.0000135334.13796.9D
[28] McDowell, A. J (1968). Goals in otoplasty for protruding ears. Plast. Reconstr. Surg. 41: 17-27. [29] Schaverien MV, Al-Busaidi S, Stewart KJ (2010).
https://doi.org/10.1097/00006534-196801000-00004
[30] Long-term results of posterior suturing with postauricular fascial flap otoplasty. J Plast Reconstr Aesthet Surg. 63(9): 1447-51.
https://doi.org/10.1016/j.bjps.2009.09.013
[31] Tan K (1986). Long term survey of prominent ear surgery: a comparison of two methods. Br J Plast Surg. 39:270-3.
https://doi.org/10.1016/0007-1226(86)90100-1
[32] Rigg BM (1979). Suture materials in otoplasty. Plast Reconstr Surg. 63(3): 409-410.
https://doi.org/10.1097/00006534-197903000-00022
[33] Thomas SS, Fatah F (2001). Closed anterior scoring for prominent ear correction revisited. Br J Plast Surg.54: 581-7.
https://doi.org/10.1054/bjps.2001.3677
[34] Mandal A, Bahia H, Ahmad T, Stewart KJ (2006). Comparison of cartilage scoring and cartilage sparing otoplasty; A study of 203 cases. J Plast Reconstr Aesthet Surg. 59:1170-6.
https://doi.org/10.1016/j.bjps.2006.01.055
[35] Sinha, M and Richard B (2012). Postauricular Fascial Flap & Suture Otoplasty; A Prospective Outcome Study of 227 Patients. J. Plast, Reconstr. Aesth. Surg. 65, 367-371.
https://doi.org/10.1016/j.bjps.2011.09.018
[36] Limandjaja G.C, Breugem C.C, Mink van der Molen, and Kon M (2009). Complications of otoplasty: a literature review. . J Plast Reconstr Aesthet Surg. 62, 19-27.
https://doi.org/10.1016/j.bjps.2008.06.043
https://doi.org/10.1016/j.bjps.2008.06.017
[2] Janis J E, Rohrich R J, Gutowski K A (2005). Otoplasty. Plast Reconstr Surg. 115(4):60e-72e. San Martín RE, et al. Otoplasty (2011). Results After Anterior Versus Posterior Approach. ActaOtorrinolaringol Esp. 62(3):188-93.
https://doi.org/10.1097/01.PRS.0000156218.93855.C9
[3] Tan S T and Gault D T (1994). When do ears become prominent? Br J of Plast Surg. 47, 573-4.
https://doi.org/10.1016/0007-1226(94)90143-0
[4] Cortes W and Gosain AK (2009). Prominent ears, in: Guyuron B, editor. Plastic surgery; indications and practice. 1st edition. Saunders Elsevier. Vol.1 p.701-716.
https://doi.org/10.1016/B978-1-4160-4081-1.50057-6
[5] Songu M and Adibelli H (2010). Otoplasty in children younger than 5 years of age. International Journal of Pediatric Otorhinolaryngology. (74) p.292-296.
https://doi.org/10.1016/j.ijporl.2009.12.010
[6] Bradbury E, Hewison J, Timmons M (1992). Psychological and social outcome of prominent ear correction in children. Br J Plast Surg. 45:97-100.
https://doi.org/10.1016/0007-1226(92)90165-T
[7] Cooper-Hobson G and Jaffe W (2009). The benefits of otoplasty for children: Further evidence to satisfy the modern NHS. J Plast Reconstr Aesthe Surg. 62, 190-194.
https://doi.org/10.1016/j.bjps.2007.09.020
[8] Adamson PC, Doud Galli S K and Chen T (2010). Otoplasty, in: Flint PW, et al. (eds) Otolaryngology: head and neck surgery. 5th edition. Philadelphia: Mosby (Elsevier). 1134I.
https://doi.org/10.1016/B978-0-323-05283-2.00034-3
[9] Converse J M and Wood-Smith D (1963). Technical details in the surgical correction of the lop ear deformity. Plast. Reconstr. Surg. 31: 118-128.
https://doi.org/10.1097/00006534-196302000-00002
[10] Mustardé JC (1963). The correction of prominent ears using simple mattress sutures. Br J Plast Surg 16:170-8.
https://doi.org/10.1016/S0007-1226(63)80100-9
[11] Mustardé J C (1967). The treatment of prominent ears by buried mattress sutures; a ten year survey. Plast. Reconstr. Surg.37:382-6.
https://doi.org/10.1097/00006534-196704000-00008
[12] Gibson, T., and Davis, W. B (1958). The distortion of autogenous cartilage graft: Its cause and prevention. Br. J.Plast. Surg.10: 257.
https://doi.org/10.1016/S0007-1226(57)80042-3
[13] Chongchet V (1963). A method of antihelix reconstruction. Br J Plas Surg.16:268-72
https://doi.org/10.1016/S0007-1226(63)80120-4
[14] Stenstrom S (1963). A natural technique for correction of congenitally prominent ears. Plast. Reconstr. Surg. 32:509-18.
https://doi.org/10.1097/00006534-196311000-00003
[15] Furnas, D. W (1968). Correction of prominent ears by conchamastoid sutures. Plast. Reconstr. Surg.42:189.
https://doi.org/10.1097/00006534-196809000-00001
[16] Kurozumi N, Ono S, Ishida H (1982). Nonsurgical correction of a congenital lop ear deformity by splinting with Reston Foam. Br J Plast Surg.35:181-2.
https://doi.org/10.1016/0007-1226(82)90160-6
[17] Yotsuyanagi T, Yokoi K, Urushidate S, et al 1998). Nonsurgical correction of congenital auricular deformities in children older than early Neonates. Plast Reconstr Surg (101:907-14.
https://doi.org/10.1097/00006534-199804040-00004
[18] Gosain AK, Recinos RF (2003). A novel approach to correction of the prominent lobule during otoplasty. Plast Reconstr Surg.112 (2):575-83.
https://doi.org/10.1097/01.PRS.0000071000.80092.2A
[19] Horlock N, Misra A, Gault DT (2001). The postauricular fascial flap as an adjunct to Mustarde' and Furnas type otoplasty. Plast Reconstr Surg. 108:1487-90.
https://doi.org/10.1097/00006534-200111000-00005
[20] Shokrollahi K, Cooper MA, Hiew LY (2009). A new strategy for otoplasty. J Plast Reconstr Aesthet Surg. 62(6):774-81.
https://doi.org/10.1016/j.bjps.2008.03.018
[21] Park C and Roh TS (2002). Anatomy and embryology of the external ear and their clinical correlation. Clin Plastic Surg . 29: 155- 174.
https://doi.org/10.1016/S0094-1298(01)00008-6
[22] Park C, Lineaweaver WC, Rumly TO, et al (1992). Arterial supply of the anterior ear. Plast Reconstr Surg. 90:38-44.
https://doi.org/10.1097/00006534-199207000-00005
[23] Nathan N et al. Otoplasty (2002). In Facial plastic and reconstructive surgery. Ira D Papel (Editors) 2nd Ed. Thieme Medical Publishers. p 309.
[24] Adamson J E, Horton C E, and Crawford H H (1965). The growth pattern of the external ear. Plast. Reconstr. Surg. 36: 466.
https://doi.org/10.1097/00006534-196510000-00008
[25] Janz B, Cole P, Hollier L and Stal S (2009). Treatment of Prominent and Constricted Ear Anomalies. Plast Reconstr Surg.124; p 27e-37e.
https://doi.org/10.1097/PRS.0b013e3181aa0e9d
[26] Matsuo K, Hirose T, Tomono T, et al (1984). Nonsurgical correction of auricular deformities in the early neonate: a preliminary report. Plast Reconstr Surg. 73:38-50.
https://doi.org/10.1097/00006534-198401000-00009
[27] Gosain AK, Kumar A, Huang G (2004). Prominent ears in children younger than 4 years of age: what is the appropriate timing for otoplasty? Plast Reconstr Surg. I l4 (5):1042-1054.
https://doi.org/10.1097/01.PRS.0000135334.13796.9D
[28] McDowell, A. J (1968). Goals in otoplasty for protruding ears. Plast. Reconstr. Surg. 41: 17-27. [29] Schaverien MV, Al-Busaidi S, Stewart KJ (2010).
https://doi.org/10.1097/00006534-196801000-00004
[30] Long-term results of posterior suturing with postauricular fascial flap otoplasty. J Plast Reconstr Aesthet Surg. 63(9): 1447-51.
https://doi.org/10.1016/j.bjps.2009.09.013
[31] Tan K (1986). Long term survey of prominent ear surgery: a comparison of two methods. Br J Plast Surg. 39:270-3.
https://doi.org/10.1016/0007-1226(86)90100-1
[32] Rigg BM (1979). Suture materials in otoplasty. Plast Reconstr Surg. 63(3): 409-410.
https://doi.org/10.1097/00006534-197903000-00022
[33] Thomas SS, Fatah F (2001). Closed anterior scoring for prominent ear correction revisited. Br J Plast Surg.54: 581-7.
https://doi.org/10.1054/bjps.2001.3677
[34] Mandal A, Bahia H, Ahmad T, Stewart KJ (2006). Comparison of cartilage scoring and cartilage sparing otoplasty; A study of 203 cases. J Plast Reconstr Aesthet Surg. 59:1170-6.
https://doi.org/10.1016/j.bjps.2006.01.055
[35] Sinha, M and Richard B (2012). Postauricular Fascial Flap & Suture Otoplasty; A Prospective Outcome Study of 227 Patients. J. Plast, Reconstr. Aesth. Surg. 65, 367-371.
https://doi.org/10.1016/j.bjps.2011.09.018
[36] Limandjaja G.C, Breugem C.C, Mink van der Molen, and Kon M (2009). Complications of otoplasty: a literature review. . J Plast Reconstr Aesthet Surg. 62, 19-27.
https://doi.org/10.1016/j.bjps.2008.06.043
Downloads
How to Cite
[1]
D. A. Abdilkarim, A. Raheem Qader, and S. Ahmed Mohammed, “The Effectiveness of Posturicular Fascial Flap as an Adjunct to Suture Otoplasty”, KJAR, vol. 1, no. 1, pp. 35–49, Mar. 2016, doi: 10.24017/science.2016.1.1.4.
Published
01-03-2016
Issue
Section
Pure and Applied Science
License
Copyright (c) 2016 Dana Abdulmagid Abdilkarim, Ari Raheem Qader, Salah Ahmed Mohammed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
