Aesthetic Plastic Surgery

, Volume 41, Issue 1, pp 56–59 | Cite as

Iatrogenic Through-and-Through Conchal Defect Secondary to Auricular Cartilage Graft

  • Hyung-Suk Ro
  • Si-Gyun Roh
  • Jin Yong Shin
  • Nae-Ho Lee
  • Kyung-Moo Yang
Case Report Face and Neck Surgery

Abstract

Background

Over the past few years, conchal cartilage has been most often used in rhinoplasty. The donor site complications following conchal cartilage graft harvesting are scar formation, hematoma formation, and delayed wound healing, although hematoma is one of the most important and common complications. A complete conchal defect as a complication of auricular cartilage graft harvesting has not been previously reported in the literature. The authors report an unusual case of an iatrogenic conchal defect resulting from conchal cartilage graft harvesting that was treated using a posterior auricular island flap.

Methods

A 24-year-old male with a left conchal inflammation and perforation visited our plastic surgery department after receiving augmentation rhinoplasty and tip plasty using a conchal cartilage graft. A tight dressing had been applied to the ear, and postoperative infection was uncontrolled, which resulted in iatrogenic conchal perforation.

Results

A tie-over bolster dressing has been widely used to prevent hematoma following conchal cartilage graft harvesting with an associated donor site complication. However, a tight tie-over dressing and inappropriate postoperative care can cause complete through-and-through conchal defects. The posterior auricular island flap provides an elegant means of reconstructing conchal defects.

Conclusions

In the described case, aesthetic reconstruction of a conspicuous iatrogenic conchal defect was achieved with minimal scarring using the posterior auricular island flap. To the best of our knowledge, this report is the first to describe reconstruction of an iatrogenic defect in the concha as a complication of auricular cartilage graft harvesting.

Level of evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Conchal defect Iatrogenic defect Posterior auricular flap Concha reconstruction 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Dessy LA, Figus A, Fioramonti P, Mazzocchi M, Scuderi N (2010) Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft. J Plast Reconstr Aesthet Surg 63:746–752CrossRefPubMedGoogle Scholar
  2. 2.
    Boccieri A, Marano A (2007) The conchal cartilage graft in nasal reconstruction. J Plast Reconstr Aesthet Surg 60:188–194CrossRefPubMedGoogle Scholar
  3. 3.
    Eren F, Aysal BK, Melikoglu C, Oksuz S (2016) Upper and middle third auricular reconstruction with a peninsular conchal flap. Arch Clin Exp Surg 5(1):1–6CrossRefGoogle Scholar
  4. 4.
    Pascali M, Gentile P, Di Pasquali C, Bocchini I, Cervelli V (2016) The auricular cartilage in 197 secondary and tertiary rhinoplasties. J Craniofac Surg 27:339–344CrossRefPubMedGoogle Scholar
  5. 5.
    Kim SW, Park CW, Kim JT, Kim YH (2012) Merocel semicompressive dressing to prevent donor-site hematoma on the conchal cartilage graft. J Craniofac Surg 23:57–60CrossRefPubMedGoogle Scholar
  6. 6.
    El Kollali R, Ghoneim I (2007) The turn-over flap for repair of an iatrogenic hole of the concha. J Plast Reconstr Aesthet Surg 60:1349–1351CrossRefPubMedGoogle Scholar
  7. 7.
    Talmi YP, Wolf M, Horowitz Z, Bedrin L, Kronenberg J (2002) “Second look” at auricular reconstruction with a postauricular island flap: “flip-flop flap”. Plast Reconstr Surg 109:713–715CrossRefPubMedGoogle Scholar
  8. 8.
    Hages I (1965) Collapsed alae strengthened by conchal cartilage (the butterfly cartilage graft). Br J Plast Surg 18:92–96CrossRefGoogle Scholar
  9. 9.
    Stark RB, Frileck SP (1969) Conchal cartilage grafts in augmentation rhinoplasty and orbital floor fracture. Plast Reconstr Surg 43:591–596CrossRefPubMedGoogle Scholar
  10. 10.
    Tardy ME Jr, Dennery J, Fritsch MH (1985) The versatile cartilage autograft in reconstruction of the nose and face. Laryngoscope 95:523–533CrossRefPubMedGoogle Scholar
  11. 11.
    Toriumi DM, Josen J, Weinberger M, Tardy ME Jr (1997) Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 123:802–808CrossRefPubMedGoogle Scholar
  12. 12.
    Becker DG, Becker SS, Saad AA (2003) Auricular cartilage in revision rhinoplasty. Facial Plast Surg 19:41–52CrossRefPubMedGoogle Scholar
  13. 13.
    Mowlavi A, Pham S, Wilhelmi B, Masouem S, Guyuron B (2010) Anatomical characteristics of the conchal cartilage with suggested clinical applications in rhinoplasty surgery. Aesthet Surg J 30:522–526CrossRefPubMedGoogle Scholar
  14. 14.
    Park C, Lineaweaver WC, Rumly TO, Buncke HJ (1992) Arterial supply of the anterior ear. Plast Reconstr Surg 90:38–44CrossRefPubMedGoogle Scholar
  15. 15.
    Masson JK (1972) A simple island flap for reconstruction of concha-helix defects. Br J Plast Surg 25:399–403CrossRefPubMedGoogle Scholar
  16. 16.
    Schonauer F, Vuppalapati G, Marlino S, Santorelli A, Canta L, Molea G (2010) Versatility of the posterior auricular flap in partial ear reconstruction. Plast Reconstr Surg 126:1213–1221CrossRefPubMedGoogle Scholar
  17. 17.
    Lewin ML (1950) Formation of the helix with a postauricular flap. Plast Reconstr Surg 5:432–440CrossRefGoogle Scholar
  18. 18.
    Papadopoulos ON, Karypidis DK, Chrisostomidis CI, Konofaos PP, Frangoulis MB (2008) One-stage reconstruction of the antihelix and concha using postauricular island flap. Clin Exp Dermatol 33:647–650CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2016

Authors and Affiliations

  • Hyung-Suk Ro
    • 1
  • Si-Gyun Roh
    • 1
  • Jin Yong Shin
    • 1
  • Nae-Ho Lee
    • 1
  • Kyung-Moo Yang
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryChonbuk National University Medical SchoolJeonju-siRepublic of Korea

Personalised recommendations