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A Temporoparietal Fascia Pocket Method in Elevation of Reconstructed Auricle for Microtia

Kurabayashi, Takashi M.D.; Asato, Hirotaka M.D.; Suzuki, Yasutoshi M.D.; Kaji, Nobuyuki M.D.; Mitoma, Yoko M.D.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 935–945
doi: 10.1097/PRS.0000000000003228
Pediatric/Craniofacial: Original Articles
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Background: In two-stage procedures for reconstruction of microtia, an axial flap of temporoparietal fascia is widely used to cover the costal cartilage blocks placed behind the framework. Although a temporoparietal fascia flap is undoubtedly reliable, use of the flap is associated with some morbidity and comes at the expense of the option for salvage surgery.

Methods: The authors devised a simplified procedure for covering the cartilage blocks by creating a pocket in the postauricular temporoparietal fascia. In this procedure, the constructed auricle is elevated from the head superficially to the temporoparietal fascia, and a pocket is created under the temporoparietal fascia and the capsule of the auricle framework. Then, cartilage blocks are inserted into the pocket and fixed. A total of 38 reconstructed ears in 38 patients with microtia ranging in age from 9 to 19 years were elevated using the authors’ method from 2002 to 2014 and followed for at least 5 months. To evaluate the long-term stability of the method, two-way analysis of variance (p < 0.05) was carried out to analyze the effect on the projection angles of the method (an axial temporoparietal fascia flap method versus a temporoparietal fascia pocket method) over long-term follow-up.

Results: Good projection of the auricles and creation of well-defined temporoauricular sulci were achieved. Furthermore, the sulci had a tendency to hold their steep profile over a long period.

Conclusions: The temporoparietal fascia pocket method is simple but produces superior results. Moreover, pocket creation is less invasive and has the benefit of sparing temporoparietal fascia flap elevation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

This and Related “Classic” Articles Appear on Prsjournal.Com for Journal Club Discussions.

Mibu and Koshigaya, Japan

From the Department of Plastic and Reconstructive Surgery, Dokkyo Medical University Koshigaya Hospital.

Received for publication October 23, 2015; accepted August 31, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Takashi Kurabayashi, M.D., Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan, m-kura@dokkyomed.ac.jp

©2017American Society of Plastic Surgeons