Temporo-Parietal Fascial Flaps to Improve Ear Reconstruction
The use of fascial flaps is a good technical procedure for ear reconstruction. My first descriptions based on anatomical cadaver dissection supported reducing the number of surgical stages when performing ear reconstruction. I demonstrated that vasculariz
- PDF / 1,391,007 Bytes
- 10 Pages / 504.57 x 720 pts Page_size
- 41 Downloads / 172 Views
Temporo-Parietal Fascial Flaps to Improve Ear Reconstruction Juarez M. Avelar
Ear reconstruction was an undeveloped field of plastic surgery until the end of the nineteenth century. Repair of congenital and acquired defects was previously performed by rotation of local skin flaps, as reported by Dieffenbach (1845). However, during the first decades of the twentieth century, especially because of World Wars I and II, this field received much attention, and many surgeons worked to improve the aesthetic results. In 1974, when I began my professional activity, there were many problems involving ear reconstruction, such as several surgical stages, postoperative complications, skin necrosis, unaesthetic results, absorption of the cartilage, prosthesis extrusion, and many other factors that caused patients to suffer. Among all these frustrating problems, there was one that needed to be solved above all: reducing the number of surgical stages necessary to perform ear reconstruction. I spent a great deal of time thinking about this and looking for a solution. Because most problems were related to poor blood supply, up to that point my attention had been directed on the necessity of bringing better vascularization to the reconstructed ear. I studied traditional anatomy books, looking for knowledge specifically regarding the anatomy of the ear and neighboring regions. As mentioned by Testut and Jacob (1975), there is a peculiar vascular network in the temporal and parietal regions that is useful to perform fascial flaps. I later concluded that it would be possible to perform transposition of arteries from neighboring areas to the auricle during reconstruc-
tion. Following much thought and intensive study of anatomy books, I performed anatomical dissections on cadavers to improve my knowledge regarding vascularization of the ear and neighboring regions. Increasing the blood supply to the reconstructed ear would achieve several goals: (1) afford greater protection to the skin, avoiding skin necrosis; (2) offer a greater blood supply to the new auricular framework during and after reconstruction; (3) attempt to reduce the number of surgical stages; (4) improve aesthetic results; and (5) minimize the suffering of patients and their relatives. I performed dissections of the ear and neighboring regions during my anatomical study of cadavers. After careful dissection, I found that it was possible to transfer soft tissue with arteries from neighboring areas to the auricle during reconstruction by rotation (Fig. 5.1a). I also found it was possible to utilize the temporo-parietal fascia, supplied by the temporal superficial artery (TSA) and the posterior auricular artery to improve blood supply during ear reconstruction (Fig. 5.1b). I was concerned about the dimensions of the fascia; would it be possible to perform rotation of soft tissue? In order to find the answer, measurement of the size and shape of the ear were demarcated as reference points on fascia (Fig. 5.1c). This procedure was performed after dissection and outward tracti
Data Loading...
