Nemir Stephanie, Hunter-Ellul Lindsey, Codrea Vlad, Wagner Richard
Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA.
Department of Dermatology, University of Texas Medical Branch, Galveston, TX 77555, USA.
Case Rep Dermatol Med. 2015;2015:484819. doi: 10.1155/2015/484819. Epub 2015 Sep 3.
A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm(2) of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection.
采用一种新型的耳后旋转门岛状皮瓣与软骨移植相结合的方法，为一名84岁男性修复耳前的大缺损。该患者因对耳轮鳞状细胞癌接受了莫氏显微外科手术。缺损大小为4.6×2.4厘米，跨越对耳轮、耳舟、一小部分耳轮以及一大段深层软骨，导致耳部结构完整性丧失且耳前部折叠。修复过程包括从耳舟窝采集1.5平方厘米的外露软骨，然后将其塑形并缝合到对耳轮软骨残端，以重建对耳轮脚。接着在耳轮缘下方切开耳后皮肤并向前折叠以覆盖软骨移植处。皮瓣通过中央皮下蒂保持相连，使用全层缺损作为模板设计的岛状皮瓣向前穿过软骨窗口，用于修复耳前部皮肤。本病例展示了旋转门皮瓣用于覆盖伴有软骨支持缺失的中央耳部大缺损的应用，并说明了软骨移植如何与皮瓣联合使用以改善切除后的耳部轮廓。
