title: A new strategy for total auricular reconstruction using prelamination of an extended retroauricular flap with tissue expansion.
abstract: OBJECTIVE
  To accomplish total ear reconstruction with aesthetic appearance is a great challenge for plastic surgeons worldwide due to insufficient skin coverage. A retroauricular fascial flap and skin graft technique are commonly used, but the results obtained are not satisfactory due to color mismatch, severe edema, and donor-site morbidity. Here, we describe a novel strategy for total ear reconstruction, utilizing an extended retroauricular flap prelaminated with tissue expansion to obtain enough skin for ear reconstruction.
  
  
  METHODS
  About 2 months before ear reconstruction, a kidney-shaped tissue expander was inserted at the mastoid region subcutaneously. The retroauricular skin became enlarged and thinner in 2 months after expansion. Next, the expander was removed and the retroauricular flap was extended by dissecting the surrounding scalp subcutaneously. By mobilizing the scalp-extended retroauricular flap, we could encapsulate the entire framework with thin and non-hair-bearing skin.
  
  
  RESULTS
  From August 2014 to September 2015, 36 microtia patients had undergone ear reconstruction using the novel strategy. Satisfactory aesthetics along with fine structure, symmetry, and maintenance of the auriculocephalic angle was achieved in all patients.
  
  
  CONCLUSIONS
  Using our novel strategy, we can obtain satisfactory aesthetic outcomes by fully mobilizing the expanded skin without additional morbidities of the donor sites. Patients are satisfied with the vivid ear contour and lack of groin scar.
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Haiyue
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, 102218, People's Republic of China.
authors.forename: Chenyu
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of ENT, China-Japan Friendship Hospital, Cherry Park Street No. 2, Beijing, People's Republic of China.
authors.forename: Jingning
authors.initials: J
authors.lastname: Chen
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Wu
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Bi
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Meirong
authors.initials: M
authors.lastname: Yang
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center of Auricular Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Badachu Road No.33, Beijing, People's Republic of China. Electronic address: 15098733987@126.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Pan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002681:China; D065817:Congenital Microtia / Q000601:surgery*; D054644:Ear Auricle / Q000002:abnormalities / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000637:transplantation*; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods; D015625:Tissue Expansion Devices; D016896:Treatment Outcome
keywords: Ear reconstruction; Flap prelamination; Microtia; Skin grafts; Tissue expansion