Balakrishnan Thalaivirithan Margabandu, Chaitra K, Christabel Prethee Martina, Rasheedha Begum U, Selvakumar C, Jaganmohan J
Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, 600003 India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):2067-2076. doi: 10.1007/s12070-023-03807-0. Epub 2023 Apr 26.
Reconstruction of upper third helico-scaphal defects (HSDs) exacts the expertise of the reconstructive surgeon. These three-dimensional defects deviate from normal facial form and cause a significant impact on the psyche of the patients. The origin, course, and dimensions of the perforators of the Eril's branch arising from superficial temporal vessels (EBSTV) were delineated by dissection and injection study. They were examined in twenty-four adult specimens. A prospective cohort study was conducted from March 2017 to March 2020, including six patients whose upper third HSDs were reconstructed with perforator plus chondro cutaneous flap based on EBSTV. After the debridement of the defect, the perforator plus chondro cutaneous flap was harvested from retro auricular sulcus skin with attached cartilages from triangular fossa and interhelical groove. The donor site was closed primarily, and the flap was rotated onto the defect. Superficial temporal vessels give a constant Eril's branch at the level of the root of the helix (otobasion superioris), which in turn divides into two perforators -superficial (lateral) and deep (medial) perforators. All six patients with post-traumatic upper third HSDs (4 males and 2 females) after reconstruction were followed for an average period of 15 months. The average age was 36.5 yrs. On average, two cartilages of maximum dimensions 3 × 2.5 mm were included in the perforator plus chondro cutaneous flap based on the medial-deep perforator of the EBSTV. In all six cases, the flaps survived without any complications. The average final computed institutional objective and subjective score was 15.67 (excellent results) (chi-square test, the p value was ( = 0.035) significant). The perforator plus chondro-cutaneous flap based on deep medial perforator of EBSTV may be a useful addendum in the armamentarium of plastic surgery. This novel reconstruction technique of upper helical defects provides good shape, size, and aesthesis of the upper external ear.
修复上三分之一耳轮-肩胛区缺损（HSDs）需要重建外科医生的专业技能。这些三维缺损偏离了正常面部形态，对患者心理造成重大影响。通过解剖和注射研究描绘了颞浅血管（EBSTV）发出的埃里尔支穿支的起源、走行和尺寸。在24个成人标本中对其进行了检查。2017年3月至2020年3月进行了一项前瞻性队列研究，包括6例用上三分之一HSDs的患者，他们采用基于EBSTV的穿支加软骨皮瓣进行重建。在对缺损进行清创后，从耳后沟皮肤连同来自三角窝和耳轮间沟的附着软骨切取穿支加软骨皮瓣。供区直接缝合，将皮瓣旋转至缺损处。颞浅血管在耳轮根部（耳上点）水平发出恒定的埃里尔支，该支又分为两个穿支——浅（外侧）穿支和深（内侧）穿支。对重建后的6例创伤后上三分之一HSDs患者（4例男性，2例女性）进行了平均15个月的随访。平均年龄为36.5岁。基于EBSTV内侧-深穿支的穿支加软骨皮瓣平均包含两块最大尺寸为3×2.5毫米的软骨。在所有6例病例中，皮瓣均存活且无任何并发症。最终计算得出的机构平均客观和主观评分为15.67（优秀结果）（卡方检验，p值为（=0.035），具有显著性）。基于EBSTV深内侧穿支的穿支加软骨皮瓣可能是整形外科手术器械库中的一种有用补充。这种新颖的耳轮上部缺损重建技术能提供良好的上外耳形状、大小和美感。
