Endoscope-assisted temporoparietal fascia harvest for auricular reconstruction.
BACKGROUND
Reconstruction of microtia may require a temporoparietal fascia flap. The authors modified existing endoscopic temporoparietal fascia harvest techniques and applied them to auricular reconstruction to reduce incision size, scarring, and visible alopecia. Flap design was altered to include posterior occipital circulation to improve perfusion and decrease venous congestion. Cases of open and endoscope-assisted auricular reconstruction techniques have not been compared in the literature.


METHODS
Seventeen patients underwent Medpor auricular reconstruction with temporoparietal fascia flaps (eight open and nine endoscope-assisted). Physical outcome (scar size, location, appearance, and complication rate), flap size, surgical times, and blood loss were compared. Equipment and dissection techniques are reviewed.


RESULTS
No flap complications occurred with either group. Endoscope-assisted incision length was 18 to 25 mm, compared with 150 to 200 mm using the open technique. No significant alopecia was noted in the endoscopic group, whereas most open patients had visible alopecia. Open surgical time averaged 325.9 minutes, and endoscopic surgical time averaged 276.5 minutes. Estimated blood loss averaged 56.3 cc for open and 45.6 cc for endoscopic procedures. Open temporoparietal fascia flap size averaged 8.87 x 9.75 cm, whereas endoscopic temporoparietal fascia flap size averaged 7.9 x 10.2 cm. Standard endoscopic brow-lift instruments were used. The optimal superior access port placement was the upper one-third/lower two-thirds junction of the flap.


CONCLUSIONS
The endoscope-assisted temporoparietal fascia harvest technique for auricular reconstruction can minimize scarring, alopecia, and surgical time, with comparable blood loss. Flap size is comparable to that of the traditional open approach. The authors recommend a broadly based pedicle instead of one based solely off the superficial temporal artery.
Helling
Eric R
ER
Honolulu, Hawaii; and San Antonio, Texas From the Plastic Surgery Service, Tripler Army Medical Center; the Plastic Surgery Service, University of Texas Health Sciences Center; and Plastic Surgery, Methodist Plaza.
Okoro
Stanley
S
Kim
George
G
Wang
Peter T H
PTH
D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000209:etiology; D001672:Biocompatible Materials; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011095:Polyethylenes; D011183:Postoperative Complications / Q000209:etiology; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting / Q000379:methods*
D001672:Biocompatible Materials; C084562:Medpor; D011095:Polyethylenes