Research & Supervision

The Effectiveness of Postauricular Fascial Flap as an Adjunct to Suture Otoplasty

A thesis submitted to the Iraqi board for medical specialization as a part of partial fulfillment for degree of Iraqi Board for Medical Specialization in Plastic and Reconstructive Surgery

By: Dr. Salah Ahmed Mohammed M. B. Ch. B

Supervised by: Dr. Ari Raheem Qader F.I.C.M.S professor of plastic and reconstructive surgery University of Sulaimania/ Iraq 2013

ABSTRACT:

BACKGROUND: Mustardé technique of otoplasty is probably the most famous and practical among all otoplasty procedures especially in our centers. Yet it possesses the risk of suture extrusion, stitch granulomas and recurrence. Such complications have been reported, albeit few,

yet they are bothersome to patients and their families. Placing tissues between the suture lines and the postauricular incision whether grafts or fascial flaps have been reported to reduce these complications.

OBJECTIVES: To evaluate the effectiveness of elevating a post-auricular fascial flap to cover the sutures in Mustardé and Furnas techniques for reducing the risk of suture extrusion and granulomas and possibly recurrence.

PATIENTS AND METHOD: Eleven patients with prominent ears (21 ears) fit our inclusion criteria. Nine of them were males and two females. They underwent suture otoplasty with post-auricular fascial flap in Burn and Plastic Surgery Hospital in Sulaimania from December 2011 to July 2013. Their mean age was 15.5 years (range from 6-32 years) with a mean follow-up period of 242 days (ranged from 66 days to 431 days (nearly 8 months)). Polydioxanone suture was used in (6 ears), and polypropylene suture was used in (15 ears).

RESULTS: We achieved ninety one percent satisfaction rates among patients and their families (72.72% were very satisfied and 18.18% were satisfied). Only one patient was unsatisfied. One patient developed partial recurrence of the middle half of antihelix in one side (4.7% ears). Another one developed bleeding that only needed pressure and change dressing in the left ear (4.7%). No suture extrusion or granuloma was reported. No patient gave the feeling of knots stabbing their ears from below.

CONCLUSIONS: Adding fascial flap to cover the sutures appears to be beneficial in preventing suture extrusions and granulomas and possibly recurrence by acting as another supporting layer. Dissecting the anterior skin for a periphery of one centimeter through the conchal excision wound beside placement of bolsters in the concha reduces the risk of anterior skin wrinkling associated with conchal excision through posterior approach.

KEYWORDS: Mustardé otoplasty, Concho-mastoid sutures, Postauricular fascial flap, Suture extrusion, Stitch granulomas and Recurrence

Correction of whistle deformity by bilobed mucosal flap technique in unilateral cleft lip

A Thesis Submitted to Iraqi board for medical specializations In partial fulfillment of the requirement for the degree of Fellowship of the Iraqi Board of Medical Specializations In Plastic and reconstructive surgery

By

Dr. Hawree A. Hassan

M.B.CH.B

Supervised by Dr. Ari RaheeQader, F.I.C.M.s. Professor: Plastic and reconstructive surgery 2013

Abstract:

Background: The whistle deformity is one of the common sequelae of secondary cleft lip deformities. It is often accompanied by asymmetric upper lip thickness and insufficient vermilion tubercle. The bilobed mucosal flap was described by Song T. to correct these deformities in a single stage. We have used the same technique in our study, and we showed that this flap can be combined with other procedure to correct wider array of secondary cleft lip deformities.

Objective: To evaluate the reliability and versatility of bilobed mucosal flap in reconstruction of whistle deformity, insufficient tubercle and lateral vermilion excess.

Method: Nine patients with whistling deformities were included in our study. Their ages ranged from 5-34 year. All cases were corrected by bilobed mucosal flap, which consist of two lobes: the first lobe located at the oral mucosa on the lateral affected lip, which is used to correct whistle deformity and augmenting the tubercle; the second lobe elevated from the lateral vermilion mucosa on the affected side and used to repair the oral mucosal defect, at the same time it decreases the excess on the lateral side.

Result: Minimum follows up was 6 month. All patients were satisfied with the aesthetic outcomes. In all of the patients, whistle deformity were corrected, tubercle augmented and more symmetric vermilion appearance were achieved. Major complications (necrosis of mucosal flap, infection and recurrence of whistling deformity) did not occur in any of the patient.

Conclusions: A bilobed mucosal flap is a safe and simple procedure, effectively performed to correct combined secondary deformities after primary cheleoplasty in unilateral cleft lip patient. It can be combined with other procedures like upper lip scar revision, repair muscular diastases, and correction of severe whistle deformity.