title: Auricular reconstruction using a novel three-flap technique improves the auriculocephalic angle.
abstract: BACKGROUND
  Skin grafting is needed for traditional auricular reconstruction. As the skin grafts contract, the postoperative framework is distorted. This leads to a decrease in the auriculocephalic angle. The objective of this study was to test a new method to cover the reconstructive framework by using three skin flaps and a larger tissue expander than that normally used. This may reduce the distortion of the reconstructed ear and create a well-shaped auriculocephalic angle.
  
  
  METHODS
  A large expander was inserted in the postauricular mastoid area. Three expanded flaps were then created to cover the anterior and posterior frameworks, with separate mastoid coverage. By measuring the height and angle at three different points on the reconstructed ear and comparing them with the contralateral normal ear, a system for measuring the auriculocephalic angle was established.
  
  
  RESULTS
  The surface of the framework and the mastoid area were covered by three flaps developed from one large tissue expander. The appearance of the reconstructed ears was similar to that of the normal side by the patient's 6- to 12-month follow-up. The difference in the distance at the three points between the reconstructed and normal sides after the three-flap reconstruction was less than that following traditional reconstruction (p < 0.05). The variation in the angle measured at these three points in the three-flap group was also much smaller than that in the traditional group (p < 0.01).
  
  
  CONCLUSIONS
  The three-flap technique not only improves the appearance of the reconstructed ear, but helps shape a perfect auriculocephalic angle.
authors: Plastic Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, People's Republic of China. Electronic address: liujiafengfeng@126.com.
authors: Liu
authors: L
authors: Jiafeng
authors: Plastic Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, People's Republic of China.
authors: Sun
authors: S
authors: Jiaming
authors: Plastic Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, People's Republic of China.
authors: Li
authors: L
authors: Xiaodan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002681:China; D065817:Congenital Microtia / Q000601:surgery*; D054644:Ear Auricle / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*; D013518:Surgery, Plastic / Q000379:methods; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods; D015625:Tissue Expansion Devices; D016896:Treatment Outcome
keywords: Auricular reconstruction; Auriculocephalic angle; Measuring; Microtia; Three flaps