Analogous to auricular reconstruction with rib cartilage, the skin of the avulsed ear can be removed and the auricular cartilage implanted into a pocket developed in the area above and behind the defect (see Figs. 10.15,10.18, and 10.30). The cartilage is sutured to the auricular cartilage stump and inserted into the pocket, and the skin of the pocket is sutured to the skin of the stump (see Figs. 10.15,10.18, and 10.30).
Fig. 10.28 Subtotal auricular defect with preservation of the helix and earlobe and an accompanying defect in the mastoid area, repaired with a rotationtransposition flap designed by Weerda (1981).
a Outline of the hair-bearing rotation flap (transport flap) and hairless transposition flap (reconstruction flap). The flap is de-epithelialized at the pull-through site, and a cartilage framework is implanted (see Fig. 10.18). b The completed repair.
Fig. 10.29 Replantation of an avulsed auricle by the technique of Baudet (1972) as modified by Arfai (1974).
a Preparation of the posterior side of the avulsed auricle. The skin is dissected back to the helical rim as a full-thickness skin flap (A). The auricular cartilage is fenestrated by excising segments down to the perichondrium on the anterior side of the auricle. b Preparation of the recipient bed on the mastoid. The flap (B) is developed toward the scalp, creating a large raw surface.
c First stage: The fenestrated cartilage is sutured and glued to the recipient bed. The postauricular skin flap (A) is attached to the mastoid flap (B) with sutures and glue. d Second stage: Three weeks later the postauricular flap (A) is separated from the mastoid flap (B), and both flaps are returned to their original positions. Residual defects are grafted with split-thickness skin (C).
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