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Reconstruction of skin and soft tissue defects of the outer ear in patients with severe burn injuries: analysis of three different operative techniques

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

An early soft tissue reconstruction is mandatory after burns of the outer ear to avoid cartilage loss. Although different procedures for covering soft tissue defects of the outer ear have been described in the past, the biomechanical properties and cosmetic outcome of reconstructed burned tissue are yet to be investigated more thoroughly.

Methods

Using photographs and the Cutometer, a device for measuring biomechanical skin properties such as firmness and elasticity, the 12 ears in six healthy volunteers and the 12 mainly deep partial-thickness injured ears in six patients who suffered burn injuries were examined. Three of the burned ears were covered with temporoparietal fascial flaps with split skin grafts based on the superficial temporal artery, four with retroauricular random pattern flaps, and five with full thickness skin graft.

Results

The median values of the firmness and elasticity of skin were approximately equal in the control group compared to the random pattern flap group. The median values of firmness and elasticity differ between the control group and the temporoparietal fascial flap and skin graft group (p = 0.05). Cosmetic outcome in terms of anatomical structures revealed full thickness grafts as the superior method.

Conclusions

Considering burn depth, the results of cosmetic outcome support the clinical principle of the reconstructive ladder, suggesting full thickness skin grafts as first choice. If high biomechanical skin quality is necessary, random pattern skin flaps from the lateral head region were the favorable procedure for burn reconstructions in the outer ear.

Level of Evidence: Level III, therapeutic study.

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Authors and Affiliations

  1. BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Baden-Würrtemberg, Germany

    Fabian Medved, Till Fischborn, Jens Martin Rothenberger, Hans-Eberhard Schaller, Manuel Held & Theodora Manoli

Authors
  1. Fabian Medved
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  2. Till Fischborn
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  3. Jens Martin Rothenberger
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  4. Hans-Eberhard Schaller
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  5. Manuel Held
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  6. Theodora Manoli
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Corresponding author

Correspondence to Fabian Medved.

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Funding

This study was not funded.

Conflict of interest

Fabian Medved, Till Fischborn, Jens M Rothenberger, Hans-Eberhard Schaller, Manuel Held, and Theodora Manoli declare that they have no conflict of interest.

Patient consent

All patients and participants were informed about the purpose of the study, following which they agreed to participate.

Ethical approval

The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as evident in the approval by the Ethics Committee of the University of Tuebingen, Germany.

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Medved, F., Fischborn, T., Rothenberger, J.M. et al. Reconstruction of skin and soft tissue defects of the outer ear in patients with severe burn injuries: analysis of three different operative techniques. Eur J Plast Surg 40, 517–524 (2017). https://doi.org/10.1007/s00238-017-1317-8

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  • DOI: https://doi.org/10.1007/s00238-017-1317-8

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