title: Bridging phenomenon - Simplifying complex ear reconstructions.
abstract: BACKGROUND
  Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flaps, described to cover these defects, demand special knowledge without which a loss of the fine detail of the ear may result.
  
  
  METHODS
  Healthy, exposed cartilage is deliberately excised leaving a basic framework for support, thus preserving contours and a well-vascularized recipient bed for full-thickness skin grafting. The grafts heal by revascularization and "bridging," a phenomenon whereby grafts on avascular beds (such as denuded cartilage) are revascularized.
  
  
  RESULTS
  By marrying clinical experience gained during microtia reconstruction with insights regarding the bridging phenomenon derived from the laboratory, our 17 reconstructed ears healed without serious complications and kept their normal contours and shape, and there was no recurrence of the carcinoma.
  
  
  CONCLUSIONS
  Satisfactory patient-centered outcome can be obtained in reconstructing defects of one-third to two-thirds of the total anterior surface of the ear relying on the bridging phenomenon.
authors: Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Jan J
authors: JJ
authors: van Wingerden
authors: Oren
authors: O
authors: Lapid
authors: Chantal M A M
authors: CM
authors: van der Horst
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D004425:Ear Cartilage / Q000637:transplantation*; D004431:Ear, External / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: basal cell carcinoma; bridging phenomenon; ear; graft; noninfiltrative; nonmelanoma skin cancer; patient-centered outcome; reconstruction