title: A New Approach for the Correction of Prominent Ear Deformity: The Distally Based Perichondrio-Adipo-Dermal Flap Technique.
abstract: BACKGROUND
  Otoplasty techniques are generally divided into 2 categories as cartilage-cutting and cartilage-sparing. The cartilage-cutting techniques have been criticized because of their high risk of hematoma, skin necrosis, and ear deformity. As a result, suture-based cartilage-sparing methods like Mustardé and Furnas-type suture techniques have become increasingly popular. However, with these techniques postauricular suture extrusion may be seen and recurrence rates of up to 25% have been reported.
  
  
  METHODS
  In this study, cartilage-sparing otoplasty is redefined by introduction of the distally based perichondrio-adipo-dermal flap which is elevated from the postauricular region. Thirty-seven ears (17 bilateral and 3 unilateral) in 20 patients (14 females and 6 males) have been operated with the defined technique by the same surgeon. The distally based perichondrio-adipo-dermal flap is advanced posteriorly to correct the deformity, also acting as a strong postauricular support to prevent recurrence. In addition to the resultant natural-looking antihelical fold, the posterior advancement of the flap corrects both the otherwise wide conchoscaphal and conchomastoid angles. The operative technique is explained in detail with results and the literature is reviewed.
  
  
  RESULTS
  There were no hematomas. After an average follow-up of 8.3 months (2-16 months), recurrence was seen in only 1 patient who requested no further surgery. No patients developed suture extrusion or granuloma.
  
  
  CONCLUSIONS
  The authors introduce a simple and safe procedure to correct prominent ears with benefits including a resultant natural-looking antihelical fold and less tissue trauma. The distally based perichondrio-adipo-dermal flap seems to prevent suture extrusion and may also help to reduce recurrence rates. By forming neochondrogenesis which is stimulated by elevation of the perichondrium, this flap gives the promise of longer durability of the newly formed antihelical fold.
authors.affiliation: *Department of Plastic, Reconstructive and Aesthetic Surgery, Acibadem Atasehir Hospital †Department of Plastic, Reconstructive and Aesthetic Surgery, MS Baltalimani Bone Diseases Training and Research Hospital ‡Private Practice, Istanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Cihandide
authors.forename: Oguz
authors.initials: O
authors.lastname: Kayiran
authors.forename: Elif Eren
authors.initials: EE
authors.lastname: Aydin
authors.forename: Adnan
authors.initials: A
authors.lastname: Uzunismail
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D002648:Child; D004425:Ear Cartilage / Q000637:transplantation; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery*; D013536:Suture Techniques; D055815:Young Adult