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Keloids are skin lesions which result from an aberration in the physiological healing process marked with overgrowth of collagen fibers. Keloid of the ear is cosmetically challenging and has an increased chance of re-growth. To minimize recurrence, pressure therapy in combination with other treatment forms has been used. Various techniques have been used to fabricate a passive or active stent. This report presents a fully digital workflow to fabricate an ear stent after intralesional excision and skin autografting of an extensive recurrence of a keloid lesion of the left ear involving the helix, antihelix, scapha and conchal bowl. This article is protected by copyright. All rights reserved.

We present the case of an 80-year-old female patient with a lesion on the right antihelix of the pinna that examined in the outpatient ENT Department of our hospital. A surgical excision of the lesion was performed, under local anesthesia. We used a superficial based pre- auricular flap to reconstruct the defect. The final postoperative result was satisfactory. The histological examination revealed a basal cell carcinoma.

Summary One of the most severe complications of auricular reconstruction for microtia is exposure of the cartilage framework. Recently, negative pressure wound therapy (NPWT) has become popular for a variety of complex wounds but reports on methods for microtia reconstruction are scarce. Thus, we aimed to detail the use of NPWT for cartilage exposure in microtia reconstruction. We retrospectively analyzed 7 cartilage exposure wounds in 6 patients treated by NPWT after auricular reconstruction for microtia. All wounds appeared from postoperative days 3 to 30 with 3 on the antihelix, 2 on the helix, 1 on the triangular fossa and 1 on the scaphoid fossa. Skin defect sizes ranged from 1 to 24 mm2 and 2 cartilage frames were infected at onset. Our NPWT system was the KCI Negative Pressure Wound Therapy with V.A.C.Ⓡ GranuFoam Black™ or Silver™ and continuous suction was applied in a range of 25–125 mmHg. All wounds healed within 8 to 39 days with NPWT antecedent cases taking longer than surgery ones. All cartilage frames survived but partial cartilage atrophies remained in 4 cases. Although a secondary infection occurred in an NPWT antecedent case it was still useful as a continuous external drainage system to remove dead space exudate and stimulate granulated tissue formation. In addition to vigilance against secondary infection, surgeons should consider an additional surgical intervention if the wound fails to improve within 7 days.

In cosmetic pinnaplasty, an underdeveloped or absent antihelical fold and a hypertrophic concha are the most frequent defects requiring surgical consultation. With this study, the authors intend to describe a technique consisting of an anterior para-helical incision to approach the antihelix, with no posterior approach. Advantages of this surgical approach are described. All patients consecutively operated in the period 2016–2019 by the senior author (FB) with the anterior incision technique were retrospectively included in the study. Demographic and comorbidities were sought. Postoperative patient’s reported pain and satisfaction were determined. Early and late complications were also mentioned. Forty-five Caucasian patients were included, of whom 23 were women and 22 were men. Mean age was 25 years old (range 14 to 52). Follow-up was from a minimum of 12 months to a maximum of 36 months. All complications were managed with an office-based approach. Patient’s satisfaction was rated as very good in most cases (25 patients, 56%), excellent in 9 cases (20%), good in 7 (16%) and fair in 4 (9%), and no one expressed poor satisfaction. The most common postoperative pain was mild. The parahelical anterior incision has proven to be a safe and effective technique for antihelical open sculpting. The scar tends to fade nicely and remain well hidden under the helical fold. The proposed technique allows an open approach to the antihelix and a surgical moulding under direct view, in addition to a limited risk of complications and an optimal balance compromising operative efficiency-efficacy and risks, patient’s and surgeon’s intraoperative comfort, appearance of the scar and duration of the result. Level of evidence: IV, therapeutic study

Summary Introduction Reconstruction of the crus of the antihelix after tumor resection is a significant surgical challenge and to date no ideal method has been described. The authors present a novel approach using a pedicled flap from preauricular excess skin, which is tunneled through the helix to the anterior auricular surface. Material and Methods The presented technique was successfully applied in a series of three patients requiring reconstruction of the superior and inferior crus of the antihelix after resection of skin malignancies. Technique and outcomes are described in detail. Results Postoperative course was uneventful in all patients and all flaps healed with excellent esthetic results. Initial flap edema was observed in two cases that resolved spontaneously. Conclusion The preauricular pull-through flap is a versatile, straightforward, and reliable method for reconstruction of auricular defects located at the superior and inferior crus of the antihelix, including the triangular fossa, using the natural preauricular skin excess.

Background Numerous methods have been developed for the correction of protruding ears. However, the best technique should be the one that is simple, reliable, and reproducible. Our research aimed to compare Mustarde technique and Stenstrom technique used in the correction of prominent ears. We included 20 patients who were randomly assigned to Mustarde or Stenstrom technique. All participants underwent full history collection, general and local examinations, and full investigations. We analyzed the age, sex, surgical technique, follow-up, complications, and results. Aim The aim of this study is to compare between Mustarde and Stenstrom techniques in the correction of prominent ear. Patients and methods This study included 20 patients with prominent ear, comprising 15 males and five females, attending Al-Azhar University hospitals. The patients were divided into two groups, with each group including 10 patients: creation of antihelix was done in all cases, and conchomastoid sutures were used if needed in some cases. Results According to our results, comparison of these two groups showed that patient satisfaction was high in both groups. In our study, hemorrhage, hematomas, keloid formations, suture extrusion, skin and cartilage infection, skin necrosis, and relapse have not occurred in any of the patients of the two groups. Irregularity in the antihelix was not observed in any patients from group A (Mustarde technique) and observed in one (5%) patient from group B (Stenstrom technique). Conclusion Minimizing the gap between the ear and the mastoid is the most significant outcome for patients in considering the operation as a success. Mustarde technique was our favorite technique for correction of protruding ear in children with soft or thin cartilage. We also agree that the technique of Stenstrom was effective in adults with hard or thick cartilage.

Background and objectives Defects of the anterior region of the pinna pose a reconstruction challenge owing to the complex topography and difficult access. We report our experience using the revolving door island flap (RDIF) to reconstruct pinna defects and present the surgical results. Material and methods Retrospective descriptive study of patients undergoing ear reconstruction using RDIF at different sites of the anterior region after resection of malignant tumors. Results Seventeen patients underwent surgery between 2011 and 2019 for squamous cell carcinoma (n = 7) and basal cell carcinoma (n = 10). Conventional histology showed disease-free surgical margins in all the resected tissue specimens. The mean follow-up period was 40 months. One local recurrence of squamous cell carcinoma was observed, which responded well to radiation therapy; all patients were free of disease at the end of follow-up. Only 3 patients presented minor complications (depression of the flap surface in 1 case and retraction of the ear toward the mastoid process in 2 cases). Subjective rating scales were used to evaluate cosmetic and functional outcomes as assessed by both the dermatologist and the patient. The normal contour of the pinna was conserved in all patients and no patients required additional corrective surgery. Conclusions Reconstruction of the pinna using RDIF allowed for satisfactory repair following complete resection of the tumors, while conserving structure and functionality. RDIF has been reported to be a very good option for reconstruction of the pinna. It is a simple technique that makes it possible to repair large defects with minimal risk of necrosis. In our series, the cosmetic results were excellent and recurrence rates were very low. RDIF provided optimal results in repairing lesions in the concha and in other regions, such as the antihelix, triangular fossa, and scapha.

Aim: The ear is a critical component of the human face functionally and aesthetically. Studies in recent years have reported that the morphological properties of the outer ear show substantial differences based on sex and ethnic group. The data obtained in these studies are guiding for plastic surgeons. Methods: This cross-sectional study was carried out on a Turkish population. Ear axis, antihelix angle, ear length, ear width, earlobe length and earlobe width measurements were made on 191 healthy adult volunteers (106 women, 85 men) between the ages of 18-25 years. Ear metric values mentioned above were compared between the genders, and correlation analysis was conducted for all. Results: All values except the antihelix angle were larger in males (P=0.0486; P, Amaç: Kulak, fonksiyonel ve estetik olarak insan yüzünün son derece önemli bir bileşenidir. Son yıllarda yapılan çalışmalar dış kulağın morfolojik özelliklerinin cinsiyete ve etnik gruba göre makul farklılıklar gösterdiğini raporlamıştır. Bu çalışmalardan elde edilen veriler plastik cerrahlar için yönlendiricidir. Yöntemler: Çalışmamız Türk popülasyonu üzerinde gerçekleştirilmiştir. 18-25 yaşları arasında 191 sağlıklı yetişkin gönüllünün (106 kadın, 85 erkek) kulak ekseni, antiheliks açısı, kulak uzunluğu, kulak genişliği, kulak memesi uzunluğu ve kulak memesi genişliği ölçümleri yapılmıştır. Tüm parametreler cinsiyetler arasında karşılaştırılmıştır ve hepsi için korelasyon analizi yapılmıştır. Bulgular: Anti heliks açısı dışında tüm değerler erkeklerde kadınlara göre daha büyük bulundu (P=0,0486; P

BACKGROUND The aim of this study is to develop a two-stage training module using radish and swine scapular cartilage for carving ear cartilage. METHODS In the first stage, white radish was cut in 3-6 mm thick slices. The ear cartilage framework was carved using a graver and the helix and antihelix were fixed with pins. In the second stage, swine scapular cartilage was obtained. The thickness varied 3-6 mm. The ear cartilage framework was made. And triangular fossa and scaphoid fossa were carved with graver. A curvilinear cartilage for helix was assembled to the framework by pin fixing. Six participants were recruited for an ear reconstruction training workshop and figures of the cartilage framework were provided. Participants were asked answer the pre-workshop questionnaire and post-workshop questionnaire on a Likert scale to rate their satisfaction with the outcome. RESULTS On the pre-workshop questionnaire, participants indicated that they did not have sufficient knowledge and skill for fabricating the ear cartilage framework (1.5± 0.5 using white radish; 1.3 ± 0.5 using swine scapular cartilage). On the post-workshop questionnaire, participants responded that they had learned useful knowledge from this workshop, reflecting a significant improvement (3.8± 1.0 using white radish; 4.0± 1.1 using swine scapular cartilage). They also indicated that they had become somewhat confident in this skill (4.2± 0.8 using white radish; 4.3± 0.5 using swine scapular cartilage. The participants generally found the workshop satisfactory (practically helpful, 4.7± 0.5; knowledge improved, 4.8± 0.4; satisfied with course, 4.5± 0.5; would recommend to others, 4.8± 0.4). CONCLUSION This model can be useful for ear reconstruction training for medical personnel.

(1) Background: Protruding ears are the most common auricular malformation affecting approximately 5% of the population. One common factor leading to auricular protrusion is a deficiency or total absence of the antihelix. A technique first described by Gottfried Lemperle in 2003 attempts cartilage thinning, folding, and fixation by non-absorbable mattress sutures after ventral skin incision along the ventral helical rim. (2) Methods: Retrospective analysis of patient records was performed for otoplasties according to this technique, performed between 1985 and 2014 at Agaplesion Markus Hospital in Frankfurt, Germany. All recorded complications were examined. (3) Results: A total of 912 single otoplasties were performed according to this technique from 1985 to 2014. Overall complications included 26% minor complications not requiring further surgery and 11% major complications leading to revision surgery. Within those requiring revision surgery, the most common reason was recurrence of auricular protrusion (5%), followed by suture granulomas (5%) and hematomas (2%). (4) Conclusions: Lemperle’s otoplasty technique addresses the open thinning and shaping of the antihelix through a ventral incision along the helix to prevent irregularities and possible ridges. Results show a low complication rate comparable to data found in published studies. This technique is easy to perform, safe, and avoids often seen contour irregularities of the antihelix compared to techniques with a posterior approach.

The base frame provides a stable support for the helix, antihelix, and tragus–antitragus complex in microtia reconstruction, and this support is vital to attain a highly defined outline for a reconstructed auricle. The success of base frame sculpting depends on appropriate treatment of the cartilage, mainly the sixth and seventh costal cartilages, which may have different characteristics. The aim of this study was to demonstrate the relevant details for base frame fabrication under various scenarios. Between 2016 and 2019, a total of 352 patients with microtia underwent autologous auricular reconstruction. Concerning the different sizes and characteristics of the costal cartilage used for the base frame reconstruction, we describe the related methods for fabrication and introduce corresponding strategies for proper management. We found that 90% of the patients responded at follow-up, and 76% of them were satisfied with the cosmetically refined auricle with harmonious integrity. The elaborate design and appropriate utilization of costal cartilage for base frame sculpting is one of the most significant and fundamental processes in microtia reconstruction. It contributes to achieving a clearly defined outline of the auricle with harmonious integrity, which is as important as the other projected subunits.

Three-dimensional (3D) printing is a leading manufacturing technique in the medical field. The constantly improving quality of 3D printers has revolutionized the approach to new challenges in medicine for a wide range of applications including otoplasty, medical devices, and tissue engineering. The aim of this study is to provide a comprehensive overview of an artificial ear splint model applied to the human auricle for the treatment of stick-out protruding ears. The deformity of stick-out protruding ears remains a significant challenge, where the complex and distinctive shape preservation are key factors. To address this challenge, we have developed a protocol that involves photogrammetry techniques, reverse engineering technologies, a smart prototype design, and 3D printing processes. Specifically, we fabricated a 3D printed ear splint model via fused deposition modelling (FDM) technology by testing two materials, a thermoplastic polyester elastomer material (Z-Flex) and polycaprolactone (PCL 100). Our strategy affords a custom-made and patient-specific artificial ear aligner with mechanical properties that ensures sufficient preservation of the auricular shape by applying a force on the helix and antihelix and enables the ears to pin back to the head.

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.

Objective: To describe the feasibility of preserving the lesser occipital nerve (LON) and the great auricular nerve (GAN) in postauricular incision in ear surgery. Methods: The distribution of the LON and the GAN was first identified in human cadavers. Then a clinical study was performed in 34 patients who underwent middle ear surgery between September 2016 and January 2017. Patients were divided into the conventional incision group and the modified incision group, according to incision types, and underwent sensory testing and subjective evaluation of auricular numbness after surgery at different times. Results: Most frequently, the auricular branches of the LON went into the postauricular groove at the same height of inferior crus of antihelix. The vertical dimension from the intersection of the highest auricular branch of the GAN and postauricular groove to intertragic notch ranged from 5.7 to –4.2 mm. Preservation of the LON and the GAN reduced sensory loss in the modified incision group compared to the conventional incision group. Conclusion: Preservation of the LON and the GAN with modified postauricular incision can reduce postoperative auricular numbness.

Background Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. Objective This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. Methods and materials Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. Results The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. Conclusion Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.

The Role of Anterior Subperichondrial Rasping inAntihelixoplasty of Prominent EarsBackground: Prominent ears also known as Bat ears is acommon ear deformity that can cause emotional problems tothe individual involved. Various techniques have been describedeach with its advantages and disadvantages.Aim of Work: The aim of otoplasty is reducing the cephaloauricularangle to 15-20 degrees, emphasis on the antihelicalfold with a smooth helical rim, concha reduction and lobulopexy.Each ear is analyzed individually regarding its problemareas and the appropriate surgical approach with least possiblemorbidity is used.Material and Methods: In this study, five patients wereoperated upon in Kasr Al-Aini Hospital between October2015 to September 2016. The authors preferred technique forsuperior crus and antihelix formation was combined anteriorsubperichondrial rasping through an ventral incision withposterior transverse mattress 3/0 polyester (Ethibond) sutureson round body needle.Conclusion: This technique is easy, efficient with satisfactoryoutcome, could be done in most patients of variousages with minimal or absent complication rate.

Chondrodermatitis nodularis helicis is an inflammatory condition affecting the helix or antihelix of the ear. It is commonly described as a solitary, painful, ulcerated nodule affecting the cartilage or skin because of continuous pressure, trauma, sun exposure, or ischemic changes. In this case report, we present a rare variant of chondrodermatitis, named chondrodermatitis nodularis nasi, which affects the skin and cartilage of the nose. Clinical resemblance to neoplasms of the skin such as squamous cell carcinoma and basal cell carcinoma requires that a biopsy be performed for definitive diagnosis. On histopathological examination, chondrodermatitis presents as a central ulcer bordered by epidermal hyperplasia, hypergranulosis, hyperkeratosis, and parakeratosis with fibrin deposits in the papillary dermis admixed with sparse inflammatory cells. Included in this case report is a discussion of the clinical and histopathology of chondrodermatitis nodularis nasi. With increased frequency of diagnosing this rare variant, better management and treatments can be explored.

Ear reconstruction is a challenging process owing to the sophisticated anatomy of the ear.The aim of facial plastic surgeons is to restore the ultimate aesthetic shape of the ear according to the anatomical considerations as smooth external contours, surface standards, and the proper physical dimensions and to ensure contentment of the patient.The auricle is most commonly associated with congenital abnormalities.Traumatic damages and pathologic disorders, especially cancer may cause acquired defects of the auricle.The chondrocutaneous helical rim advancement flap (CHRAF) described by Antia and Buchis a good method of reconstructing defects of the helix and the modifications that have been reported broadened the scope of its use to large defects and defects extend beyond the helix A variant of CHRAF includes a pedicle flap based on ear lobule providing blood supply (axial) to the flap named Ear Lobe Based Flap.Aim of the workThe aim of this studywas to assess the versatility of the chondrocutaneous helical rim advancement flap with its different modifications when needed for the reconstruction of marginal auricular defects that include the helix alone or may extend onto the scapha, antihelix, and triangular fossa.

Auricular acupressure therapy is a simple and effective means of health care and has gradually gained popularity. As an important prerequisite for auricular acupressure therapy, auricular point localization is difficult for general public. Most auricular points are distributed within eight regions, including helix, scapha, fossa triangularis, antihelix, concha, antitragus, tragus, and earlobes, which are divided according to the auricle’s anatomical structure. In this paper, an improved YOLACT method is applied to segment the eight regions of the auricle automatically, and the accuracy is up to 93.2% on the ear dataset of 1000 images. Achieving segmentation of the auricular region, which can greatly narrow the localization area of auricular point, will provide an important foundation for the automatic localization of auricular point, favoring nonexperts to increase their understanding of auricular acupressure therapy or the development of an intelligent instrument related to auricular acupressure therapy.

Reconstruction of the antihelical area can be challenging because the cartilage can be easily exposed due to the thin overlying soft tissue, and it has a lack of tissue mobility. Skin graft can be hesitant to perform in antihelical defects where the bare cartilage is exposed.A 70-year-old male with squamous cell carcinoma of the antihelix of the left ear was referred to our department for surgical excision. Wide excision with tumor-free margins resulted in a defect of 2.0 × 1.0 cm with exposed bare cartilage. The authors covered the defect using adipoperichondrial turnover flap from cephalic portion of the earlobe followed by full thickness skin graft. The skin graft took well with no complication. Aesthetic result was satisfactory with no auricular deformity.This adipoperichondrial turnover flap is simple, easy, can be performed in one stage, and produces good esthetic results with no disfiguration of the ear shape.

BACKGROUND In the repair of prominent ear deformities, the main objectives are to recreate the antihelical fold, reduce projection in patients with a large concha, and normalize the distance between the ear and the cranium. This study evaluated the efficacy of the adipo-perichondrial flap-assisted posterior auricular muscle complex (PAMC) flap technique, which involves a new approach to the repair of prominent ear deformities. MATERIALS AND METHODS A medially based PAMC flap and a laterally based adipo-perichondrial flap were elevated in 22 patients with prominent ear deformities. In order to shape the ear, the PAMC flap was sutured to the transition zone between the helix and antihelix, and the adipo-perichondrial flap to the periosteum of the mastoid bone. The ear-cranium distances were measured preoperatively and at postoperative first and sixth months. RESULTS Thirteen patients were female and 9 were male. The mean age of the patients was 19.4 years, and the mean follow-up period was 10.6 months. The ear-cranium distance significantly decreased in the postoperative first-month and sixth-month evaluations compared to the preoperative values (P

Background Chondrodermatitis nodularis helicis (CNH) is a common chronic condition characterized by a tender nodule on the helix or antihelix of the ear which may or may not have accompanying crusting, scaling, or ulceration and that is often difficult to treat. Objective Develop an easy, effective, and durable treatment to reduce the pain and clinical signs including ulcerations associated with CNH using injectable hyaluronic acid (HA). Materials and methods Twenty-four patients were injected and followed up in 2 to 4 weeks intervals using 0.2 to 0.3 mL of various HA with a high G-Prime. Results Injectable HA significantly improved the symptoms and also the clinical appearance of all patients treated after 1 or 2 injections except 1 patient. Extrusion of the material through a preexisting ulcer usually required a second follow-up injection 2 weeks later. No adverse events were noted with the injections other than the intentional visible bulging of the injected region with HA. Conclusion Injectable HA provides almost immediate relief from the discomfort of CNH in most cases in less than 1 or 2 weeks, significantly improves the clinical appearance over time and resolves accompanying ulcerations.

Although many prominent ear deformity (PED) surgery techniques have been described to date, there have been few comprehensive studies evaluating the recurrence rates in different age groups. Previous studies have focused either on the young or the elderly. The present clinical study compares recurrence rates among patients of different age groups undergoing PED repair and discusses cartilage morphology. A total of 380 patients with a mean age of 24.2 years underwent PED repair surgery between 2001 and 2019. The patients were divided into five subgroups according to age. Group I (5–10 years) was composed of 44 patients, Group II (10–20 years) was composed of 47 patients, Group III (20–30 years) was composed of 166 patients, Group IV (30–40 years) was composed of 90 patients, and Group V (over 40 years) was composed of 33 patients. The cephaloauricular angle (CAA) and the distance between the helix (upper, middle, lower) and mastoid were measured and recorded prior to surgery. The patients were all treated with three concha-mastoid sutures to achieve concha reduction and to narrow the cephaloauricular angle. The anterior aspect of the cartilage was thinned with a rasp, and an antihelix was created using non-absorbable sutures in patients with an inadequate antihelix. The CAA and the upper pole-mastoid distance were measured immediately after surgery and at 15 days, 3 and 6 months after surgery. Recurrence was observed in a total of 18 patients, with PED recurring in one patient in Group I (2.3%), three patients in Group II (6.38%), 10 patients in Group III (6.8%), three patients in Group IV (3.3%) and one patient in Group V (3.03%). Although the difference in the recurrence rate among the age groups would appear to be clinically significant, the difference was not significant, statistically. Clinically, the differences among the groups could be attributed to intragroup numerical differences. In the present study, no significant relationship was identified between the patient age and recurrence rate. Although PED repair is recommended in the preschool period, prominent ear repairs can be carried out in any age group, although the degree of cartilage scoring should differ depending on the age group. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective This study aimed to introduce a new technique for the correction of mild or moderate types of cryptotia. Methods During January 2010 to March 2015, patients with cryptotia deformities came to our hospital and were enrolled in this study. A new surgical method of correction of abnormal cartilage by combining irregular incisions in auricle malformation and directional transplantation of auricular cartilage was designed. The irregular Z shaped flap was designed to correct the skin defects. In the ipsilateral cavum conchae, the auricular cartilage strut was harvested, followed with irregular cartilage incisions and cartilage transplantation. Results After correction, the corrected auricles in 3 cases showed natural contour with deep auriculotemporal sulcus and no conspicuous scars. The antihelix folding and backward rotation deformities of the auricular cartilage were corrected, and the morphology of superior and inferior crus of the antihelix was not destroyed. One case appeared necrotic. During 1 year of follow-up, there was no incidence of recurrence or revision. Conclusions The combined techniques for correction of abnormal cartilage are simple and easy to operate, and the reconstructed auricles show natural contour without conspicuous scars. The new technique is suitable for correction of mild and moderate cryptotia.

Background Multiple techniques have been advocated over the years for correction of the prominent ear. The basic techniques used to correct prominent ears with a missing antihelix depends on incision, scoring, bending and reposition of the auricular cartilages. This study was undertaken to correct prominent ears using cartilage incision and vertical mattress sutures to define antihelix. Patients and Methods This study was carried out on 13 patients (25 ears) in the period between February 2014 and June 2017, twelve patients of them were presented with bilateral prominent ears and one patient was presented with unilateral prominent (bat) ear. This series comprised 8 males and 5 females. Their ages ranged between 7 to 33 years. In this technique 2 parallel incision in auricular cartilage, definition of antihelix with vertical mattress sutures and ellipse of skin was removed. Results Satisfactory results were obtained in all patients. Complications occurred in 2 patients only: one of them had mild protrusion of upper third of auricle and the other had keloid. Conclusion Our technique produces natural-looking of the operated ears with low complication rates.

Background Total auricular reconstruction is currently one of the most challenging plastic surgery procedures. Herein, we present our 10-year experience with 1350 cases of ear reconstruction by using Nagata method with necessary improvement. Methods Factors related to ear reconstruction, namely, remnant ear, mastoid skin, adjacent scalp, rib cartilages, normal ear, and mastoid process, were carefully evaluated before operation. An individualized design and precise framework fabrication were performed for each patient. Necessary modifications in fabricating base frame, helix, tragus, and antihelix were introduced to achieve a stable and individualized framework. These efforts also reduced the quantity of cartilage required for ear reconstruction. Results Follow-up time ranged from 1 month to 5 years, and 1217 (90.1%) patients were satisfied with the reconstructed ears, which showed appropriate color, texture, size, and location. The modifications made conferred a harmonious and individualized contour of the reconstructed ears. Incidence of all complications such as hematoma, skin necrosis, and framework absorption was very low. Conclusions Based on preoperative assessment, individualized design, and precise sculpting, a harmonious and individual auricle with detailed anatomical structures was achieved by using our modified Nagata method in which a stable and sophisticated framework can be fabricated with less cartilage requirement.

The authors propose a novel surgical technique for reconstruction of full-thickness defects of the middle portion of the auricle including the helix and the antihelix up to the neighboring portion of the concha and sparing the whole of the ear lobe. It is a single-stage procedure that is indicated when a large, redundant, and pendulous earlobe exists as typically occurs in the elderly patient. The earlobe is rotated into the full-thickness ear defect and fits as an inlay between two cartilaginous stumps. The ear lobe presents two anatomical patterns: the pendulous or free one, with the ear lobe lying free from the cheek, and the non-pendulous or attached one, where the ear lobe is attached to the cheek. Donor site deformity is therefore limited to the conversion of a pendulous ear lobe pattern into an attached one. Surgery may be scheduled in an outpatient basis as the procedure is easy to plan, is fast to perform, and is carried out under local anesthesia. Level of Evidence: Level IV, therapeutic study.

The main causes of acquired auricular defects are surgical treatment of skin tumors and trauma. Due to the complex anatomy of the external ear, surgical reconstruction of defects in this area is challenging for surgeons, especially in case of midhelix-antihelix involvement with significant loss of soft tissue and cartilage. Our purpose is to illustrate the main reconstructive techniques of large midhelix and antihelix defects, as well as the advantages or disadvantages associated with each surgical procedure. Primary closure/wedge technique is mainly used in elderly, multimorbid subjects where single-stage procedures are desirable, but several complex chondrocutaneous, retroauricular, temporoparietal full-thickness flap procedures can also be used to recreate an ear with normal appearance. Auricular reconstruction of large midhelix-antihelix defects requires a good knowledge of auricular anatomy and the various surgical procedures available for such defects.