title: Supermicrosurgical reconstruction for congenital aural atresia using a pure skin perforator flap: concept and long-term results.
abstract: BACKGROUND
  Several surgical methods for creating an external auditory canal have been developed in step with clinical innovation. However, revision surgery is often required to address complications, which include external auditory canal stenosis, lateralization of the tympanic membrane, and chronic recurrent otorrhea. These complications occur frequently within 6 to 12 months after surgery. To decrease the incidence of complications, the authors reconstruct the external auditory canal and tympanic membrane in patients with congenital aural atresia using a free pure skin perforator flap that is as thin as a skin graft. They report their outcomes for hearing acuity and complications over 12 months after the operation.
  
  
  METHODS
  The authors performed reconstruction of the external auditory canal and tympanic membrane in nine patients with congenital aural atresia. The flap design was based on a pure skin perforator derived from the groin area in eight patients. The flap was folded into an approximately 1.5×3-cm sac and inserted into the external auditory canal. Anastomosis was performed between the perforator vessels and superficial temporal vessels.
  
  
  RESULTS
  All pure skin perforator flaps survived, although one case had partial epidermal necrosis. The audiologic follow-up period ranged from 12 to 24 months (mean, 17 months). The mean pure-tone average was 65.1 dB (range, 53 to 80 dB) preoperatively and improved to 32.4 dB (range, 8 to 53 dB) postoperatively. None of these cases showed any potential complications.
  
  
  CONCLUSIONS
  This flap may therefore reduce complications and help to maintain hearing acuity in the long term.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Tokyo, Japan From the Departments of Plastic and Reconstructive Surgery and Otorhinolaryngology, Tokyo University School of Medicine.
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Akinori
authors.initials: A
authors.lastname: Kashio
authors.forename: Shotaro
authors.initials: S
authors.lastname: Karino
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000013:Congenital Abnormalities / Q000601:surgery*; D004423:Ear / Q000002:abnormalities / Q000601:surgery; D004424:Ear Canal / Q000002:abnormalities / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D014432:Tympanic Membrane / Q000002:abnormalities / Q000601:surgery