Partial necrosis of expanding postauricular flaps during auricle reconstruction: risk factors and effective management.
BACKGROUND
Tissue expansion has gradually become accepted as a useful adjunct to auricular reconstruction. Necrosis of postauricular flaps during the expansion phase may hinder auricular reconstruction. This study was designed to investigate the risk factors for partial necrosis of expanding postauricular flaps during reconstruction of the auricle and to provide effective management strategies.


METHODS
Data were gathered retrospectively for cases of partial necrosis of expanding postauricular flaps from the overall group of patients undergoing auricular reconstruction after preliminary tissue expansion at a treatment center from January of 2002 to January of 2005. Demographic data, ulcer occurrence, treatment procedure, and results were analyzed statistically.


RESULTS
The authors observed that 2.5 percent of congenital microtia cases and 13.8 percent of acquired auricular defect cases suffered from partial necrosis of expanding postauricular flaps. Necrosis in more cases occurred during static expansion and was located on the inferior part of the expanded flap. Treatment included the following: (1) auricular reconstruction with autologous costal cartilage or a porous polyethylene framework for a limited term; (2) continuing static expansion, with the postauricular flap extended and fixed in place after expander removal; and (3) removal of the expander and reinsertion of a similar expander more than 6 months after the wound had healed. Each method was applied to different types of cases. Most cases obtained a satisfactory contour and profile of the reconstructed auricle.


CONCLUSIONS
Some individual and iatrogenic factors are involved in partial necrosis of expanding postauricular flaps, which can be prevented and minimized. An optimal method can be chosen to treat every case of partial necrosis of the expanding postauricular flap.
Jing
Chen
C
Guangzhou and Beijing, People's Republic of China From the Department of Burns and Plastics, Nanfang Hospital, Southern Medical University, and Plastic Surgery Hospital, Peking Union Medical College.
Hong-Xing
Zhuang
Z
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery; D004425:Ear Cartilage / Q000637:transplantation; D004426:Ear Deformities, Acquired / Q000601:surgery*; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D009336:Necrosis / Q000453:epidemiology / Q000473:pathology; D011336:Probability; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000473:pathology*; D013997:Time Factors; D015626:Tissue Expansion