Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective S
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ORIGINAL ARTICLE
FACE AND NECK SURGERY
Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective Study Datao Li1 • Ruhong Zhang1 • Qun Zhang1 • Zhicheng Xu1 • Feng Xu1 Yiyuan Li1 • Xia Chen1
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Received: 8 February 2020 / Accepted: 26 March 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Abstract Background Skin grafts, frequently used for ear elevation in ear reconstructions, may suffer from color mismatches, scar hypertrophy, secondary contraction, and auricular sulcus depth differences. To determine the most suitable donor area, we compared the contralateral postauricular area, groin, and scalp as potential donor sites. Methods Since 2008, we have used three donor sites for obtaining skin grafts used in ear reconstructions. Fullthickness groin skin, split-thickness grafts from the scalp, and contralateral postauricular and groin composite fullthickness skin grafts were used in 202, 231, and 195 patients, respectively. Photographic assessments were used to assess color matching, sulcus depth, cranioauricular angle symmetry, and flatness of the skin grafts; surgical complications were also documented. Results Among the three donor sites, there were no significant differences in the color matching scores (p = 0.456). The scalp donor scores had significantly lower mean scores for sulcus depth and symmetry and for graft flatness scores than the other donor sites. The assessment scores between the groin and postauricular donor groups were similar. Each donor site was associated with some surgical complications. However, postauricular skin, when combined with groin skin, demonstrated the best cosmetic results and the fewest complications.
& Ruhong Zhang [email protected]; [email protected] 1
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China
Conclusion All three donor sites are viable options for skin graft donor sites in ear elevation surgeries. Although the advantages and disadvantages of each site should be explained to the patient, the ultimate donor site selection may be determined according to patient and surgeon preferences. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Ear elevation Ear reconstruction Skin graft Microtia
Introduction The two-stage ear reconstruction procedure, described by Nagata [1] and by Firmin [2], has been widely used since its publication. During the first stage, an autogenous costal cartilage framework is inserted into a skin pocket in the desired area, the tragus is fabricated, and the lobule is repositioned. During the second stage, the cartilage grafted ear is elevated and the wound
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