title: Periosteal Flap Technique for Elevation of the Pinna in Microtia.
abstract: OBJECTIVE
  For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts).
  
  
  METHODS
  The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting.
  
  
  CONCLUSIONS
  The periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.
authors.affiliation: Head and Neck Surgery Unit, Prosper Hospital, Ruhr University, Recklinghausen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Siegert
authors.affiliation: Plastic, Reconstructive, and Burn Management Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Saad Mohamed Saad
authors.initials: SM
authors.lastname: Ibrahiem
authors.affiliation: Head and Neck Surgery Unit, Prosper Hospital, Ruhr University, Recklinghausen, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Magritz
mesh_terms: D000328:Adult; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010521:Periosteum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps