Invited Discussion on: Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor S
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective Study Akira Yamada1
Received: 24 May 2020 / Accepted: 27 May 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V 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. The authors use three-stage total auricular construction for microtia. Representative cases demonstrated excellent esthetic outcomes in terms of ear definition. And reported complications related to tissue expander methods, usually high in the literature, are relatively low in this case series. I would like to congratulate authors for the results. The authors tried to find the best skin donor sites for ear elevation in this study. The authors stated that among the three skin donor sites, there were no significant differences in the color matching scores (p = 0.456). But also the authors stated that the color difference between the grafted skin from the groin and surrounding skin is obvious. This tells that photographic assessment used in this study did not capture the obvious skin color difference between groin skin and postauricular skin. Among plastic surgeons, it is common sense; I assume that the authors agree that groin skin is a poor color match when it was grafted on face, including the ear area. The authors concluded that the highest score was given to the combination of postauricular skin and groin
skin. But the authors did not make a definite recommendation on which skin donor site is best among the three choices. As shown in Fig. 1, this patient came to see me for a second opinion; the groin skin is pale in color, and the surrounding color has a more ‘red’ tone that makes clear the boundary between the different skins. As the child grows, as the authors also stated, pubic hair growth bothers patients in the long term (Fig. 1). The problem of this study was that the scoring system included the parameter other than skin color marching. Poor cephalo-auricle sulcus is more related to the skeletal support and soft tissue coverage of cartilage, other than skin itself. The authors did not give us the information on how cartilage support was placed and how this was covered by the flap. These are more important contributing factors,
& Akira Yamada [email protected]; [email protected]; https://www.luriechildrens.org/en/doctors/yamada-akira/ https://www.luriechildrens.org/en/specialtiesconditions/pediatric-plastic-surgery/photos-videos/ 1
Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL 60611, USA
Fig. 1 Microtia patient came to see me from OSH for s
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