Tunnelized superior anterior auricular artery chondrocutaneous flap for tragal zone reconstruction after tumor excision
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IDEAS AND INNOVATIONS
Tunnelized superior anterior auricular artery chondrocutaneous flap for tragal zone reconstruction after tumor excision G. Cottone 1,2
&
D. Zilio 1 & F. Borelli 1,2 & F. Amendola 1,2 & L. Vaienti 1,2
Received: 6 August 2019 / Accepted: 17 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Despite the constitutional small size, the tragal zone plays an essential functional and morphological role. Little has been said about the tragal zone reconstruction after tumor excision in the literature. In this paper, we present a novel, smart, and safe idea to reconstruct the abovementioned anatomical region after a radical tumoral excision: the superior anterior auricular artery chondrocutaneous flap. Level of evidence: Level V, therapeutic study. Keywords Tragus . Ear . Chondrocutaneous . Flap . Reconstruction
Introduction The tragus and the peritragal area are considered essential landmarks in the overall artistic and anatomical landscape of the ear [1, 2]. Despite the constitutional small size, these elements perform a big functional role: to cover and hinder direct access to the ear canal as well as to give a solid strut to prevent the collapse of the outer third of the ear canal (whom anterior and lower wall are formed by the elastic cartilage as anatomical continuation of the cartilage framework of the pinna). Moreover, being retroverse, the tragus aids in collecting sounds from behind; these sounds are delayed Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00238-020-01638-8) contains supplementary material, which is available to authorized users. * G. Cottone [email protected] 1
Division of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
2
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Milan, Milan, Italy
more than sounds arriving from the front, assisting the brain to sense front vs. rear sound sources and ensuring a tridimensional hearing function. Last but not least, from the aesthetic point of view, the tragal zone embodies an important role in defining the tridimensional morphology of the auricle, not only by covering the meatus but also by casting a shadow into the conchal bowl that gives the impression of depth [3]. For the last two decades, surgeons paid more attention to the shape of the tragus and peritragal zone. In spite of this, much of the collective experience in the reconstruction of the abovementioned site stems from microtia reconstruction [4]. Little has been said about the tragal zone reconstruction after tumor excision, today [5, 6]. We present a novel and, in our view, interesting idea to reconstruct this small but significant area after a radical tumoral demolition.
Case presentation Case 1 was a 78-year-old man with a tragal nodular skin lesion (confirmed by pathologists as nodulocystic basal cell carcinoma according to WHO classification of skin tumors [7], firm and anchored to the underlying
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