title: An Alternative Posterosuperior Auricular Fascia Flap for Ear Elevation During Microtia Reconstruction.
abstract: BACKGROUND
  Advances in staged total auricular reconstruction have resulted in improved anterior auricular appearance; however, satisfactory postreconstruction esthetics of the retroauricular fold remain challenging. The postauricular appearance of the reconstructed ear depends largely upon optimizing the covering material. When used as the covering soft tissue for ear elevation, a flap containing primarily the upper portion of the retroauricular fascia has potential advantages over the conventional book cover-type retroauricular fascia flap.
  
  
  METHODS
  We developed a geometrically designed, posterosuperior auricular fascia flap to replace the conventional retroauricular fascia flap for ear elevation. During the second-stage operation, the posterosuperior auricular fascia flap is rotated downward and turned over to wrap around the inner strut and entire posterior auricular surface.
  
  
  RESULTS
  Compared to the conventional book cover-type retroauricular fascia flap, the novel posterosuperior auricular fascia flap was easier to harvest and the operative time significantly decreased (110.3 vs. 121.5 min, p < 0.01). The modified flap produced a thin and natural contour of the postauricular surface, as well as reduced the incidence of postauricular hypertrophic scarring (from 24.7 to 13.2%, p = 0.03) and partial skin graft necrosis (from 43.4 to 31.2%, p = 0.01).
  
  
  CONCLUSIONS
  The geometrically designed posterosuperior auricular fascia flap improves ear elevation. Compared to the conventional book cover-type retroauricular fascia flap, this covering tissue is easier to perform so the surgical time is decreased. It was highly vascularized, well defined, thinner, and yields reliable results. Thus, favorable postauricular surface results can be achieved during auricular reconstruction by using the modified fascia flap.
  
  
  METHODS
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authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
authors.forename: Yiyuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China. zrhm@msn.com.
authors.forename: Ruhong
authors.identifier: http://orcid.org/0000-0001-8124-0257
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
authors.forename: Datao
authors.initials: D
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000601:surgery / Q000637:transplantation*; D002648:Child; D015331:Cohort Studies; D065817:Congenital Microtia / Q000175:diagnosis / Q000601:surgery*; D054644:Ear Auricle / Q000002:abnormalities / Q000601:surgery; D004954:Esthetics; D005205:Fascia / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Ear elevation; Ear reconstruction; Microtia