A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects
Abstract
Introduction
Materials and Methods
Results
Cutaneous Flaps
Non-Circumferential Defects
Pre-EAC Based Flaps
Posterior-EAC Based Flaps
Circumferential Defects
Fascial Flaps
Temporoparietal Fascial Flap
Conclusion
Funding
Conflicts of Interest
References
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Flap name | Type of flap | Tissue type | Advantages | Disadvantages | References |
---|---|---|---|---|---|
Tragal flap | - Random pattern - Advancement flap | - Cutaneous | - Patent EAC good for cancer surveillance and good audiometric outcomes | - Potential poor cosmesis | [3] |
Superficial temporal artery (STA) perforator island flap | - Axial - Island | - Cutaneous | - Single stage procedure - Non hair bearing donor site with good skin match and inconspicuous scars - Patent EAC results | - Limited by depth of defect | [9] |
Wessex flap | - Axial - Pivotal - transpositional | - Cutaneous | - Single stage - Non hair bearing | - Limited by depth of defect | [10] |
Superficial temporal artery (STA) interpolated flap | - Axial - Interpolated | - Cutaneous | - Reliable for salvage defects without need for skin grafting | - Two staged procedure | [11] |
Conchal bowl flap | - Random pattern - Pivotal – transpositional flap | - Cutaneous +/− cartilage | - Good option in post surgical or radiated fields | - Skin graft needed for secondary site - Limited to defects the size of or smaller than the conchal bowl and adjacent to it | [2,12] |
Tunneled transposition flap | - Random pattern - Pivotal - interpolated/island | - Fasciocutaneous | - Reliable flap site based off laser Doppler assessment - All incisions closed primarily | - Likely limited to smaller EAC defects based off the pedicle to length ratio and accommodating the tunneled pedicle | [13] |
Postauricular island flap | - Axial - Island | - Fasciocutaneous +/− muscle +/− cartilage | - Reliable blood supply - Low morbidity and good cosmetic option for large auricular defects - Patent EAC | - Possible posterior pinning of pinna or prominent ear lobule - Make require skin grafting of the harvest site | [2,14,15,16,17,18,19,20,21] |
Anterior pedicled retroauricular flap (APRF) | - Random pattern - Pivotal – interpolated flap | - Cutaneous | - Good aesthetic result - Tension free - Can be used for full-thickness defects involving the helix | - Multistaged | [22,23] |
Square screw flap | - Random pattern - Pivotal – transpositional flap | - Cutaneous | - Can be used for full circumferential defects - Fewer incisions - Shorter recovery - Better cosmesis - Decreased FN risk | - Not suitable for larger tumors (>T2), thick subQ fat, strong skin tension | [24] |
Laterocervical twisted (snail) flap | - Random pattern - Pivotal – transpositional flap | - Fasciocutaneous | - Patent EAC good for cancer surveillance and good audiometric outcomes - Single stage reconstruction of full circumference EAC, conchal and tragal defects - Cosmetically favorable and reliable donor site | - Potential prolonged stent placement - Not suitable for patients with thick subQ fat, strong skin tension - Theoretically can put the marginal mandibular nerve at risk | [25] |
Temporoparietal fascial flap | - Axial - Hinge or pivotal – transpositional flap | - Fascia +/− cutaneous | - Reliable and versatile - Used for large defects | - Potential alopecia - Potential damage to the frontotemporal branch of the facial nerve | [26,27,28] |
Superficial temporal artery (STA) turnover fascial flap | - Axial - Hinge flap | - Fascia | - Good for large defects | - Requires skin grafting | [2,29] |
Middle temporal artery flap | - Axial - Pivotal - transpositional flap | - Fascia, periosteum +/− muscle | - Thin, pliable, robust flap - Less risk of atrophy - Good for cases at risk of poor wound healing or revision cases | - Requires skin grafting for cutaneous defects | [30] |
© 2024 by the author. The Author(s) 2024.
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Gibson, A.C.; Speed, O.; Boyette, J.R.; Saadi, R. A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects. Craniomaxillofac. Trauma Reconstr. 2024, 17, 59. https://doi.org/10.1177/19433875241262619
Gibson AC, Speed O, Boyette JR, Saadi R. A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects. Craniomaxillofacial Trauma & Reconstruction. 2024; 17(4):59. https://doi.org/10.1177/19433875241262619
Chicago/Turabian StyleGibson, Anna Celeste, Olivia Speed, Jennings R. Boyette, and Robert Saadi. 2024. "A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects" Craniomaxillofacial Trauma & Reconstruction 17, no. 4: 59. https://doi.org/10.1177/19433875241262619
APA StyleGibson, A. C., Speed, O., Boyette, J. R., & Saadi, R. (2024). A Systematic Review of Local Flaps Utilized for External Auditory Canal Defects. Craniomaxillofacial Trauma & Reconstruction, 17(4), 59. https://doi.org/10.1177/19433875241262619