According to the contour of the external ear, the skin of the posterior margin was cut, and the fascia flap, which was 1.5~2cm wider than the flap, was lifted at the same position, and the auricular cartilage scaffold was implanted between the two flaps to form a 45-degree cranioauricular angle. Skin grafting and postoperative treatment of the wound are the same as above. You can also cut 8~9cmx7~8cm superficial temporal fascia island flap in the temporal area, wrap the auricle bracket, transplant full-thickness or medium-thickness flap, and wrap it after shaping. This method is suitable for abnormal position of residual ear, shallow hairline, skin loss in ear area, acquired total ear defect and scar in mammary sinus area behind ear.

Matters needing attention

According to different methods, surgical incision and residual ear treatment are selected to ensure the survival of local skin flap. The residual ear can be treated in the first stage, the second stage or the last stage, which is not contradictory.

Second, the tissue expander method

60~ 100ml half-moon expansion sac was buried in the normal skin peeling cavity behind the ear or above the ear hairline, and it was expanded by conventional method 1~2 months after wound healing. Take out the dilator and remove the capsule formed around the expansion sac on the flap. Cover the prepared auricle bracket with skin flap. If there is a residual wound behind the auricle, full-thickness or medium-thickness skin graft must be planted for fixation, suture and shaping, or continuous pressure suction should be placed under the skin flap to make the skin flap fit the stent, and it should be taken out after 3 days, and then wrapped with gauze for 7~ 10 days. After 3 months, the residual ear was transferred for earlobe reconstruction. This method is suitable for post-traumatic repair of hairline arc, residual ear arc, anophthalmia, tight skin and failed ear reconstruction.

Matters needing attention

1, a thin layer should be left under the skin when the auricle is peeled off, not too thin, and the blood supply of the flap should be paid attention to when the capsule is taken out after expansion, and the peeling should not be too deep to prevent abnormal damage to the facial nerve.

2. The fixed suture used for shaping should be used alternately, and it should not be too tight to prevent the flap from necrosis.

3. Tissue expansion method does not advocate rapid expansion, so as to avoid the exposure of expansion sac and the retraction of Y flap after operation, resulting in auricle deformation. Expansion can be properly exceeded, and after a period of time, it is more ideal to re-operate the expanded flap without contraction at all.

4. If the auricle bracket is exposed, it should be handled in time. The small one can heal itself by local dressing change, and the big one needs skin flap coverage. Stents made of allogenic, heterogeneous and artificial materials may lead to surgical failure and should be used with caution.

Third, auricle adhesion

It is a deformity caused by part or most of auricle cartilage attached to the lateral wall of skull. The auricle is flat on the cranial side, and there is no cranial ear groove. The development of auricle cartilage is generally good. The operator is required to separate the adhesion, put the auricle in a normal position, and form a v-y push flap, Z plasty or full-thickness skin graft behind the ear. Place the model to prevent the cranial ear groove from retracting.

Fourth, external ear trauma.

(a) the cutting injury is caused by sharp instruments, which can be one or more places. The wound is generally neat and can only be the whole skin or auricle. Debridement should be conservative, and the wound edge should be layered directly after hemostasis. Those whose blood supply is obstructed or has been cut off, those whose diameter is less than 65438±0cm, are replanted according to the principle of composite tissue section, and those who are too large are buried under the flap behind the ear and shaped in two stages.

(2) The avulsion injury is caused by external violent tearing. Partial or total avulsion, irregular wound, skin and cartilage avulsion degree may be different. It may be accompanied by crush injury and scalp avulsion injury. 【 Treatment principle 】 After debridement, those with good blood supply can be sutured. For patients with poor blood supply, the auricular cartilage scaffold with thin soft tissue can be preserved, and the temporal fascia flap and skin graft can be used for primary reconstruction, or the auricular cartilage can be buried under the skin behind the ear for secondary repair. Total ear avulsion with superficial temporal vessels can be replanted for microvascular anastomosis.

Five, cauliflower-like ears

Subchondral hematoma or cartilage fragmentation and chondritis of auricle caused by various reasons (such as crush injury, trauma, burn infection, etc.), if not handled properly in time, can cause hematoma tissue proliferation and cartilage folding and thickening, so that auricle thickens and swells and loses its normal shape, and its surface often forms multiple hard and compressed raised nodules, showing cauliflower-like deformity. It will affect hearing. The treatment is difficult and the effect is not ideal. Surgical repair can be performed after the condition is stable. The thickened cartilage and fibrotic tissue were removed, and the contour was thinned according to the shape. The auricle cartilage scaffold was reassembled with the cut cartilage. After 1~2 months, the auricular cartilage scaffold was wrapped and shaped according to the shape.

Six, helix and earlobe defects

The defects of helix and earlobe are mostly caused by trauma, burn, tumor resection and infection. When the defect is less than or equal to 1/3 of the total length of the helix, the skin and cartilage on both sides of the defect can be cut along the helix groove and peeled off under the skin behind the ear. Wedge-shaped excision of part of auricle will promote direct suture of bilateral skin flaps, or this method will reduce the defect area and then take the composite tissue piece of the opposite auricle for transplantation. If the defect is greater than 1/3, a cartilage scaffold can be implanted at the defect and covered with a flap behind the ear. According to the repair principle of microtia, the defect can also be repaired by covering cartilage scaffold with temporal fascia flap or embedding dilator and expanded flap behind the ear. Part or all of the defect of the helix can also be repaired by transferring the small skin tube to the edge of the defect for "edging". Partial defect of earlobe can be sutured directly by V-shaped incision. All defects can be reconstructed with self-folding flap in mastoid, which should be slightly larger than the original earlobe, and the flap can be delayed if necessary. The shape of the earlobe will be repaired in the second stage.

Seven, external auditory canal atresia or stenosis

Congenital atresia is mostly complete, often accompanied by middle ear hypoplasia. Hearing impairment is seen in congenital microtia. Acquired patients are mostly caused by scar contracture after burn, infection or trauma (including surgery), which may affect hearing slightly, and cholesteatoma of external auditory canal may occur in severe cases, even involving tympanic membrane, middle ear and mastoid sinus. X-ray examination can understand the middle ear and mastoid process.

Principles of treatment

Surgical excision of scar release contracture can restore the shape, diameter and conduction function of external auditory canal. Wrap a rubber or plastic tube with a flap of medium thickness so that the meat faces outwards for implantation. After the skin graft survived, it was supported for 6 months to prevent retraction. Membrane scar or reticular scar at the mouth of external auditory canal can be repaired by local staggered flap or "Z" plasty.