Abstract

LLANOS, S. et al. Refinements on reconstruction of auricular upper pole defects with Davi's technique: Anatomical study and clinical series. Cir. plást. iberolatinoam. [online]. 2009, vol.35, n.2, pp.115-122. ISSN 1989-2055.

Acquired defects of the upper third of the ear constitute a surgical challenge. Several techniques have been described, and results are sometimes unfavorable. An anatomical study in 10 fresh cadavers shows the constant presence of a neurovascular pedicle penetrating the root of helix. Location and vessel diameters are shown. Based on that anatomical knowledge, a series of 10 consecutive cases treated by the senior author is presented. Etiology, surgical technique, complications and long-term results are analyzed. The author's technique introduces a refinement of the Davis' technique, which uses a pedicled chondrocutaneous rotation conchal flap, cutaneous based on the upper auricular branch of superficial temporal artery. An axial pedicled superiorly based retroauricular flap provides the coverage of the new superior helical rim, and the posterior aspect of the chondrocutaneous flap is then covered with a full thickness skin graft. In a second stage, a Z plasty on the root of helix brings it a natural shape All the anatomical dissections demonstrate the presence of a neurovascular pedicle penetrating the root of the helix. The clinical series is composed by 8 traumatic defects, 1 electrical burn and 1 benign skin tumor. All flaps survived and so demonstrated pedicle safety. Two retroauricular flaps presented vascular deficit, one of them with complete spontaneous restoration and the other one with small distal cutaneous necrosis. Two cases suffered partial skin graft loss. Some technical details were developed while the series went on, which are discussed. All 9 patients recovered auricular contour, which seems better for us using the above described refinements. As a conclusion, the Davis's technique represents an effective method to reconstruct the upper pole of the ear. Some technical refinements can improve the results with this approach, achieving a more natural contour of the reconstructed area.

Keywords : Ear; Auricular reconstruction; Davi's flap.

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