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20-11-2011 | Surgery | Article

Postauricular fascial flap prevents extrusion, recurrence in suture otoplasty


Free abstract

MedWire News: Addition of a postauricular fascial flap during suture otoplasty using Mustarde's technique prevents suture extrusion and reduces the risk for recurrence with a low complication rate, show study findings.

Over 200 techniques have been described for prominent ear correction, with anterior scoring techniques associated with an increased risk for anterior hematoma and related complications such as skin necrosis or deformed cartilage, which may be difficult to correct surgically.

Mustarde's technique of suture otoplasty has been shown as safer than anterior scoring procedures, although it has been associated with variable suture extrusion and recurrence rates of up to 24%.

Bruce Richard and Manish Sinha, both from Birmingham Children's Hospital, UK, performed suture otoplasty using Mustarde's technique with addition of a postauricular fascial flap in 227 children aged 6-16 years during 2002-2010. Patients were reviewed after 8-10 days.

Of the 227 cases, 19 procedures were unilateral and 60% of patients received general anesthesia. Operations were performed by registrars and consultants in 42% and 32-58% of cases, respectively.

In total, 10 patients (4.4%) experienced complications, with 6 patients (2.6%) showing suture extrusions. All suture extrusions were managed in an outpatient basis, with only one recurrence of deformity occurring.

In addition, one patient had a head bandage-related bilateral anterior skin ulcer that healed using conservative measures. Keloid scarring occurred in three patients (1.3%).

Recurrences occurred in 4.8% of patients, with all but one of the 11 recurrences requiring correction. These were operated with a repeat of the original technique showing a satisfactory outcome.

The observed success rate among studied patients was high, with 97% showing a good or excellent outcome at the time of final review.

Writing in the Journal of Plastic, Reconstructive and Aesthetic Surgery, the team concludes: "A large proportion of cases were operated by trainees and we have found this technique to be simple, safe and easy to learn.

"The technique avoids the dangers of anterior dissection as in anterior scoring and minimizes the risks of anterior skin necrosis and cartilage necrosis."

By Ingrid Grasmo

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