Refinements in Elevation of the Reconstructed Auricle: The “Zigzag Incision”

Objective: Auricular elevation with superficial temporal fascia and skin graft is widely used in microtia reconstruction using costal cartilage. However, in some patients, there has been occurrence of contraction of skin graft, which led to insufficient projection of the elevated auricle and diminished auriculocephalic angle with unfavorable long-term results. In this article, the authors introduce their multiple triangular flaps with zigzag incision to maintain stable projection and natural retroauricular sulcus appearance in auricular reconstruction patients. Methods: The authors have designed zigzag incision along the lateral margin of the ear framework to prepare triangular flaps targeting the root of the helix or inferior half of the auricle. Depending on the extent of remnant skin coverage, the number of triangular flaps is varied. The posterior raw surface of the ear framework was covered with triangular flaps and full-thickness skin graft. Results: Zigzag incision was conducted in 22 microtia patients who underwent auricular elevation using superficial temporal fascia and skin graft. Mean follow-up period was 2 years and there were no reports of occurrence of surgery-related complications, specifically skin necrosis, infection, or hematoma. The auricular projections were well maintained and auriculocephalic angle of the constructed auricles was similar to the healthy ears. Conclusions: The author's method comprises comparatively easy techniques and leads to good projection of the auricular angle. A zigzag incision using the triangular flaps could be an attractive surgical option for preventing shrinkage of grafted site and in achieving sufficient projection in autologous reconstructed auricle. Address correspondence and reprint requests to Kap Sung Oh, MD, PhD, Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine Irwon-dong 50, Gangnam-gu, Seoul 135-710, Republic of Korea; E-mail: kapsung.oh@samsung.com Received 10 April, 2017 Accepted 11 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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