Cordova A, D'Arpa S, Pirrello R, Giambona C, Moschella F
Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Via del Vespro 129, 90127 - Palermo, Italy.
J Plast Reconstr Aesthet Surg. 2008;61 Suppl 1:S44-51. doi: 10.1016/j.bjps.2007.09.004. Epub 2007 Oct 24.
The retroauricular skin has always been given much attention by the reconstructive surgeon for ear and face reconstruction because it is richly vascularised, as many anatomical investigations show, it is hidden behind the ear, its skin is very similar to that of ear and face. All these reasons make it an ideal donor site for ear reconstruction. The authors propose their own algorithm for reconstruction of every kind of anterior defects of the auricle with different Retroauricular Island Flaps (RIFs) based on the location and size of the defect developed over a 16 years single institution's experience with a series of 216 consecutive cases.
216 patients have undergone ear reconstruction with RIFs from 1999 to 2006. In 52 a Superior Pedicle RIF (SP-RIF) was used for defects of the upper half of the auricle. In 68 cases a Perforator RIF (P-RIF) was used for conchal reconstruction. In 96 cases an Inferior Pedicle RIF (IP-RIF) was used for reconstruction of nonmarginal and superficial marginal defects of the auricle.
No flap failure was recorded. Excellent morphological reconstruction was obtained with these flaps with no sequealae at the donor site in terms of form and function. Only in the case of P-RIFs the sulcus becomes flat in its central part, but this has never affected the possibility of wearing spectacles. The SP-RIFs may sometimes show some signs of venous stasis that invariably resolve in the first two postoperative days.
The retroauricular skin may be considered a flaps bank for ear reconstruction. It offers in fact a great variety of island flaps that are suitable for every kind of loss of substance of the ear, have a safe vascularisation, skin of similar colour and texture, are easy to harvest under local anaesthesia on an outpatient basis and cause no relevant morbidity at the donor site. Location and size of the defects lead the choice between the different types of RIFs.
耳后皮肤一直备受重建外科医生关注，用于耳部和面部重建，因为许多解剖学研究表明其血管丰富，位于耳后不易暴露，且其皮肤与耳部和面部皮肤非常相似。所有这些原因使其成为耳部重建的理想供区。作者基于16年来在单一机构对216例连续病例的经验，根据缺损的位置和大小，提出了使用不同耳后岛状皮瓣（RIFs）重建各种耳廓前部缺损的算法。
1999年至2006年，216例患者接受了RIFs耳部重建。52例使用上蒂RIF（SP-RIF）修复耳廓上半部分缺损。68例使用穿支RIF（P-RIF）进行耳甲重建。96例使用下蒂RIF（IP-RIF）修复耳廓非边缘性和浅边缘性缺损。
未记录皮瓣坏死情况。这些皮瓣实现了极佳的形态重建，供区在形态和功能方面均无后遗症。仅在P-RIFs的情况下，耳甲腔中部会变平，但这从未影响佩戴眼镜。SP-RIFs有时可能会出现一些静脉淤血迹象，但在术后前两天内总会消退。
耳后皮肤可被视为耳部重建的皮瓣库。实际上，它提供了多种岛状皮瓣，适用于各种耳部组织缺失情况，血管化安全，皮肤颜色和质地相似，易于在局部麻醉下门诊采集，且供区无相关并发症。缺损的位置和大小决定了不同类型RIFs的选择。
