SCAPHA AURICULA SKIN

The reconstruction has a shorter operative time and is tolerated well by patients under local anaesthetic.Preservation of even a small part of this subunit permits aesthetically convincing reconstruction. In our experience, defects of the inferior third, including the lobule, are suitable for star-pattern reconstruction also. The consequence of reconstructing these larger defects is pseudo-microtia but only in cases of extensive defects is this noticeable. Whilst a defect size of 25mm has been described as the maximum limit for star-pattern reconstruction, in our experience it can be successfully used to reconstruct defects of any size. The dressing is removed after five days and the wound reviewed by the operating surgeon seven days post-surgery, with further review one month later.

Formal head bandaging is avoided because of the shearing effect it can apply to the wound. The helical rim is closed with a vertical mattress suture to provide better wound edge eversion, avoiding notching between the advanced superior and inferior limbs of the helical rim (FigureВ 4).ДЇigure 4: Closure of the helical rim and medial auricular surface completes the reconstruction.Д«actroban ointment is applied to the wound, which is then covered with a Mepore dressing. The central limb of the star-pattern is closed initially using 4-0 vicryl rapide sutures, followed by the outer limbs (Figure 3).ДЇigure 3: Closure of the central and outer limbs provide good approximation and tension-free closure.

SCAPHA AURICULA SKIN

Incisions are made perpendicular to the skin and remove the skin from both the lateral and medial surfaces of the auricle, along with the cartilage to avoid bowing on wound closure (FigureВ 2).ДЇigure 2: Cartilage and skin from the contralateral surface are removed, facilitating closure and avoiding auricular bowing. A fresh scalpel blade is used to excise the star-shaped pattern from the auricle to avoid cartilage spicules forming that interfere with wound closure. A number 15 scalpel blade is used to remove the lesion and margins, with a 3-0 silk marking suture placed at the 12В oвЂ™clock position to allow histopathological orientation. An aperture drape is suitable, as tissue is not being mobilised into the wound from a separate region. The skin is cleaned with 7.5% providone-iodine and skin infiltrated with three to four vials of Lignospan special (lidocaine hydrochloride 2% with 1:80,000 adrenaline). The length of each limb is no more than 50% of the defectвЂ™s length, allowing excellent edge approximation, particularly at the helical rim (Figure 1).ДЇigure 1: Auricular lesion with excision margin and three-limbed star-pattern design. The star-pattern includes three limbs spanning the length of the defect resulting from the initial wide local excision. It is relatively quick to design and perform compared to other types of advancement reconstruction describedвЂќ вЂњWe have found the star-pattern advancement reliable in preserving skin, auricular cartilage and form. Scapha tissues are preserved and the shorter operative time makes the reconstruction more tolerable for the patient and suitable to being performed under local anaesthetic.

It is relatively quick to design and perform compared to other types of advancement reconstruction described. We have found the star-pattern advancement reliable in preserving skin, auricular cartilage and form. Techniques in reconstructing large defects centre on postauricular grafting or a variety of forms of advancement involving skin and cartilage. In our experience, wedge excision is rarely suitable when reconstructing the auricle, as lesion sizes and their necessary margins produce considerable defects. The auricle height is also reduced, although this change is usually subtle. Closure of larger lesions using this approach increases the risk of wound dehiscence and produces distortions in the auricle with anterior bowing. Wedge excision with primary closure is suitable for defects smaller than 15mm in size in the upper and middle third of the auricle. Poor cosmesis can result from the altered appearance and asymmetry with the contralateral auricle. These can produce auricular defects that interfere with the use of spectacles, hearing aids, face masks and other medical devices. Greater peripheral and deep excision margins are therefore required to ensure high rates of complete removal. Skin malignancies developing on the auricle continue to be regarded as high-risk lesions due to their propensity to recur and for lymphatic spread. We describe our approach to straightforward reconstruction of the peripheral auricle using the established star-pattern design.

Scapha auricula