The Clinical Application Of Reserving Subcutaneous Pedicle At Mastoid Area In Nagata’s Method Of Auricular Reconstruction

Objectives：To prove that reserving the Subcutaneous pedicle in mastoid areacan increase the blood supply of this area; to explore the indication,location and the size of subcutaneous pedicle for guiding the cliniclapplication in Nagata`s method of ear reconstruction surgery.Methods：From june2013to march2014,46patients who diagnosed microtiawere undertreated with Nagata`s method in ear reconstruction. Patientswere randomly divided into two groups, and we did19patients withoutsubcutaneous pedicle in mastoid area, the region of dissection was largerthan rim of cartilage frame-work by1.0cm. In other19patiens wepreserved a vertical subcutaneous pedicle at the point where located at11mm～13mm horizontally to the remnant tragus accrossed with8mm～10mm vertically to lowest pole of earlobe, the pedicle diameter is3mmto5mm wide, and the other procedure was the same with Nagata method.The follow-up was1～12months which had an average of4.5months.Postoperative results were statistically analyzed and compared.Rusult：In non-perserving subcutaneous pedicle group,4cases (21.1%) hadpoor blood supply and partial necrosis or necrosis of flap rim occurred in5cases(26.3%) in follow-up time. Necrotic areas were2cm×1cm～ 0.3cm×0.3cm which were covered by anteriorauricular flaps orpostauricular flaps. In another group,delayed wound healing occurred in1cases(3.7%) in follow-uptime. All located at tip of flaps without anynecrosis which were healed by wound caring.There were significantdifferences between two groups(P<0.05).Conclusion：1. our clinical results demonstrate the retention of subcutaneouspedicle that can indeed increase the blood supply of mastoid skin flap,reduce the incidence rate of flap necrosis;2. our propose is a pedicle position that has a distance about11mm~13mm from residual ear tragus and8mm~10mm from the lowestpoint of residual ear lobes, this area is the projection of cavum conchaepart.The pedicle diameter is3mm to5mm wide, thus, this kind ofpedicle not only can insure the blood supply of the skin flap but also cannot influence the placement and rotation of reconstructive cartilageframework. The reservation of subcutaneous pedicle in mastoid areaespecially suitable for patients with ear-lobe type.