title: Inverted u-shaped purse and rotation flaps: correcting the inferoposterior deformity of reconstructed ears after canaloplasty of the external auditory meatus.
abstract: BACKGROUND
  After patients with congenital microtia receive external ear canal plasty, the mastoid area usually has insufficient space for ear reconstruction. Hence, after ear reconstruction, an inferoposterior position deformity of the ear appears to some extent. Using inverted U-shaped purse and rotation flaps can correct this deformity effectively.
  
  
  METHODS
  From May of 2009 to September of 2011, five patients received the described procedures in the authors' department. Inverted U-shaped purse and rotation flaps were used for all the patients. The inverted U-shaped purse flap was used to reduce the area of the canal orifice and to lower the position, and the rotation flap was applied to turn the ear in a more superoposterior position. Two patients also received full-thickness skin grafting to cover the secondary wound. In four patients, V-Y-plasty or Z-plasty was used to adjust the flap transition.
  
  
  RESULTS
  For the five patients, the distances between the ear antihelix and canal orifice were shortened, and the areas of the canal orifice were diminished. The retroversion of the auricle was corrected in various degrees, and the angles of the long axis of the auricle and the horizontal line were increased an average of 14.4°. The vertical distance between the top of the helix and the center of the canal orifice was increased an average of 15.2 mm. A slight dog ear deformity in front of the crus of the helix was left after the operation, but it was alleviated in the follow-up period.
  
  
  CONCLUSIONS
  By using inverted U-shaped purse and rotation flaps, the inferoposterior position deformity of the reconstructed ear after external ear canal plasty in congenital microtia can be resolved effectively.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
authors.affiliation: Department of Plastic Surgery, Sun Yat-sen Memorial Hosptial, Sun Yat-sen University, #107 of Yanjiang Street, Guangzhou City, Guangdong Province, China.
authors.forename: Chenyang
authors.initials: C
authors.lastname: Ji
authors.forename: Jinming
authors.initials: J
authors.lastname: Zhang
authors.forename: Geng
authors.initials: G
authors.lastname: An
authors.forename: Weiqiang
authors.initials: W
authors.lastname: Liang
authors.forename: Shujuan
authors.initials: S
authors.lastname: Pan
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Chen
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wei
authors.forename: Ganlin
authors.initials: G
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D002648:Child; D000013:Congenital Abnormalities / Q000601:surgery*; D065817:Congenital Microtia; D004423:Ear / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult