title: Pure skin perforator flap for microtia and congenital aural atresia using supermicrosurgical techniques.
abstract: Microtia or pinna deformities with congenital aural atresia are severe conditions that significantly affect the quality of life. Although several surgical treatments have been proposed for aural atresia, revision surgery is often required to address complications associated with the initial procedure, which include external auditory canal stenosis, lateralization of the tympanic membrane and chronic recurrent otorrhea. However, such problems may be addressed by using vascularized skin. We herein report a new method of reconstruction for congenital aural atresia in three cases using the superficial circumflex iliac artery as a pure skin perforator flap.
  
  
  METHODS
  The branch of the superficial circumflex iliac artery perforator was traced distally to a point where it penetrated the dermis. After identifying the branch of the perforator penetrating the dermis (termed the "pure skin perforator"), the pure skin perforator flap was elevated. A new external auditory canal was then created by drilling through the mastoid air cells and atresia plate. The pure skin perforator flap was folded into a 1.5×3 cm sac, which was placed into the external auditory canal. The superficial circumflex iliac artery and the superficial circumflex iliac vein were anastomosed to the superficial temporal artery and the superficial temporal vein, respectively.
  
  
  RESULTS
  All of the pure skin perforator flaps survived. The flap sizes varied from 10×2.5 to 10×4 cm (average area of 32.5 cm2). These skin perforator flaps were all 2 mm thick.
  
  
  CONCLUSIONS
  Pure skin perforator flaps fed only by the dermal subpapillary plexus survived, regardless of the presence of the subdermal plexus. The pure skin perforator flap can be as thin as a skin graft and it has the possibility to reduce the complications that frequently occur when the previously reported procedures are used.
authors: Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. sancho-ps@um.in.ac.jp
authors: Mitsunaga
authors: M
authors: Narushima
authors: Tatsuya
authors: T
authors: Yamasoba
authors: Takuya
authors: T
authors: Iida
authors: Takumi
authors: T
authors: Yamamoto
authors: Hidehiko
authors: H
authors: Yoshimatsu
authors: Hisako
authors: H
authors: Hara
authors: Azusa
authors: A
authors: Oshima
authors: Takeshi
authors: T
authors: Todokoro
authors: Kazuki
authors: K
authors: Kikuchi
authors: Jun
authors: J
authors: Araki
authors: Makoto
authors: M
authors: Mihara
authors: Isao
authors: I
authors: Koshima
mesh_terms: D000293:Adolescent; D000328:Adult; D000013:Congenital Abnormalities / Q000601:surgery*; D065817:Congenital Microtia; D004423:Ear / Q000002:abnormalities / Q000601:surgery; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult