How to Avoid Postauricular Suture Extrusion in Otoplasty

INTRODUCTION

The Mustardé technique has been criticized because of a high incidence of postauricular suture extrusion^1, The nonabsorbable suture creates undulation at postauricular skin that retains dirtiness and may promote skin maceration.

OBJECTIVES

The objective is to present a technique of grafting different tissues between Mustardé sutures and postauricular skin to avoid suture extrusion.

PATIENTS AND METHODS

Only Patients with antihelix malformation were included in this study. The study compared two groups: Control Group and Graft Group

Control Group

From April of 2006 to July of 2009, 50 patients (35 male and 15 female) had otoplasties performed by the author. There were 47 bilateral and three unilateral procedures (97 ears). The patients ranged in age from 7 to 59 years, (median-25). Length of follow-up ranged from 6 to 18 months (median-12). All patients had sutures placed with 4-0 multifilamentar nylon.

Graft Group

From August of 2009 to December of 2011, 62 patients (38 male and 24 female) had otoplasties performed by the author. There were 60 bilateral and two unilateral procedures (122 ears). The patients ranged in age from 6 to 65 years (median- 27). Length of follow-up ranged from 2 to 17 months (median-8.5). All patients had sutures placed with multifilamentar nylon 4-0. Three different tissues were used:

1. Cartilage. In 55 patients cartilage graft was obtained from conchal reduction and inserted between the nylon suture and the postauricular skin.
2. Fat. In 4 patients the fat graft was inserted.
3. Galea. In 3 patients the galea graft was was inserted.

RESULTS

At Control Group five patients (5.2 percent of the ears)  developed postauricular suture extrusion.

At Graft Group no patient developed postauricular suture extrusion or granuloma. In every patient the postauricular skin presented a flat surface.

DISCUSSION

The placement of graft seems to provide a barrier between the suture and the skin. It promotes a smooth surface at the postauricular skin and avoids contact between the skin and the sutures and knots.

CONCLUSION

We conclude that the placement of graft tissues between the Mustardé sutures and the postauricular skin avoids suture extrusion in 100 percent of the cases.

REFERENCES

 

1. 1.        Horlock , N. The Postauricular Fascial Flap as an Adjunct to Mustardé and Furnas Type Otoplasty. Plast. Reconstr. Surg. 108: 1487, 2001.