Minimal-Scar Ear Reconstruction Using Endoscopic Temporalis Harvest and Thin Split-Thickness Scalp Skin Graft with Allodermis

Purpose: Ear reconstruction procedures involve both functional and aesthetic considerations. Especially, auriculoplasty requires a symmetric ear shape free of any deformities and with minimal scarring in the donor. Medpor ear reconstructions have been performed as options of atypical microtia, burned ear, bilateral microtia, etc., as rib-cartilage ear reconstruction. A key merit of the Medpor framework is that they do not cause any chest scars or deformities, which makes the operation viable for preschool children. Furthermore, endoscopic-assisted superficial temporalis fascia flap harvest requires no scalp incision. An allodermis graft with thin scalp skin can be used for the temporalis flap coverage instead of the conventional use of full-thickness skin from the lower abdomen, groin, or opposite retroauricular area. The goal of concealing scars and avoiding body deformities pose new challenges for ear reconstruction.

Materials and Methods: 142 patients underwent Medpor auricular reconstruction with endoscopic-assisted tempoparietal fascial flaps harvested using the scalp as thin split-thickness skin graft with allodermis, simultaneously from January of 2014 to December of 2017. 22 patients had undergone meatoplasty before ear reconstruction. 9 cases were bilateral microtias, 46 were atypical-type microtias, and 96 were typical type microtias.

Results: No flap complications occurred except 6 traumatic Medpor exposures which could be corrected by using the deep temporal fascia flap, including partial temporalis muscle and skin graft. 3 cases involved Medpor removal due to Pseudomonas infections. Bipolar dissections of the temporal scalp flap undersurface caused 2 temporal burn alopecias. 2 cases showed skin graft donor alopecia due to mechanical problems with the equipment. After substitution of the dermatome, no further alopecia occurred.

Conclusions: Ear reconstruction by both endoscope-assisted temporoparietal fascia harvest without a superior access port and thin split-thickness (0.3–0.4 mm) scalp skin graft with allodermis can minimize scalp scarring and alopecia in addition to causing no body scars.

 

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