a) Wedge-shaped resection (Fig. 10.4) A helical defect caused by a small tumor resection or injury can be closed by extending the defect to a wedge shape (Fig. 10.4a). Small, full-thickness
Fig. 10.5 Small helical resection defect repaired by the Ger-suny technique (1903) (Weerda modification). a Following tumor resection, a curved two-layer incision is made in the scapha, and a Burow's triangle is excised in the earlobe.
b The entire helix is mobilized on the postauricular skin, and the wounds are closed. c A dog ear is excised on the postauricular surface.
Burow's triangles ensure a very good esthetic result (Fig. 10.4b).
Defects in various portions of the helix can be repaired with a slight decrease in auricular size by cutting along the scapha and excising Burow's triangles from the earlobe and the postauricular skin (Fig. 10.5a, c).
As in the Gersuny technique, defects are closed by cutting along the scapha and advancing the helix and the crus, which is incised around its perimeter (see Fig. 10.9a-c).
d) Z-plasty technique of Weerda (1980) (Fig. 10.7) An acquired wedge-shaped helical defect or a congenital coloboma can be closed by an auricular Z-plasty (Fig. 10.7). Argamaso and Lewin (1968) and Spira (1974) described a similar technique (Fig. 10.8).
e) Anterior superior auricle (Weerda 1989) (Fig. 10.9) With defects in the anterior superior auricle, the preauricular defect can be closed with a rhomboid-shaped Dufourmentel flap (Fig. 10.9a) or a transposition flap (see Figs. 3.26, 8.13, and 8.24). The Gersuny technique (see Fig. 10.5) can then be used to repair the upper anterior helix (Fig. 10.9b).
Fig. 10.6 Small helical defect reconstructed by the technique of Antia and Buch (1967) (see Fig. 10.5). a The wound edges are freshened.
b An incision is made around the crus, and the postauricular skin is dissected. c An incision is made along the scapha into the earlobe, and a small Burow's triangle is excised. d Closure of the defects does not significantly decrease auricular size.
Fig. 10.7 Lateral defect closed by the Z-plasty technique of Weerda (1980). a Defect.
b The wound edges are freshened, and two-layer acute-angled flaps are cut, one based superiorly (1) and the other inferiorly (2). The postauricular skin is mobilized.
c The flaps are transposed, closing the defect and drawing the earlobe upward.
Fig. 10.8 Lateral defect closed by the technique of Argamaso and Lewin (1968).
a A preauricular Dufourmentel flap is cut (see Figs. 3.26, 8.13, 8.18, and 8.24), and the helix is shifted forward as in our modified Gersuny technique (see Fig. 10.5). b The completed repair.
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