J Korean Soc Plast Reconstr Surg.  1999 Sep;26(5):1062-1068.

Rhiltral Reconstruction in Facial Burn Scars using Fenestrated Auricular Composite Graft

• Kim MG
• Seo HH

Abstract

The surgical correction of postburn nose and lips deformities still remains a difficult task domain to be done by plastic surgery. Consequently, the performance of autogenous cartilage graft and ear cartilage graft to maintain a better philtral form were found to raise the problem of a defect in the unnatural form due to consecutive tension in the region. Recently, focus had been placed on composite graft, including auricular cartilage, to obtain a unique dimple in the philtrum, and concurrently with this, part of its natural form has been acknowledged. However, composite graft on scar beds with poor circulation on the recipient site dose not represent safe survival, has increased risk allotment, which laeds to difficult application. From Jan. 1992 to Dec. 1998, the authors have experienced auricular composite graft in 15 patients who had a defect on the philtrum due to postburn scar contractures. As types of this operation, in method I, the subcutaneous pocket is made at the midline of the upper lip. The next step is cartilage insertion into subcutaneous tissue. The cartilage graft is fixed to be overlying skin by the bolus sutures. In Method II, the recipient site is excavated by some excision of the soft tissue in the central upper lip after scar tissue excision. The obtained auricular skin composite graft is placed and fixed to the philtral area. In Method III the auricular skin composite graft is harvested, and 2 or more 2mm-sized multiple holes are made along the midline of cartilage. Then composite graft is fixed to the defects of philtrum. The elongated portion of the distal tip of cartilage is embedded into the vermilion tubercle for sprouting and fullness. The most effective method was Method III, which enhanced the survival of auricular cartilage graft and its overlying skin, by trimming the margin of grafts, and enhancement of the connecting vessels through fenestrated holes of cartilage between the recipient site and composite graft. The authors hereby report the results of the present study along with study findings based on literature surveys.

MeSH Terms

Burns*
Cartilage
Cicatrix*
Congenital Abnormalities
Contracture
Ear Cartilage
Humans
Lip
Nose
Skin
Subcutaneous Tissue
Surgery, Plastic
Sutures
Transplants*