PREFABRICATION OF AURICLE WITH ABDOMINAL FLAP AND CARTILAGE IN RABBIT

ABSTRACT

Ear reconstruction with conventional modalities necessitates time consumming, expenses and multi-stage operations, a lot of time, and cost. Although single stage ear reconstruction with vascularized temporoparietal fascia has been developed, it is not always suitable due to precious surgery or trauma. Recently, prefabrication of a secondary island flap by transferring axial vessels and revascularizing target tissues has been attempted. The prefabricated composite secondary island flap can be transferred to other sites by micro-vascular anastomoses of the axial vessels in a second stage operation. In 10 rabbits, a 5x11cm sized bipedicled abdominal flap including panniculus carnosus muscle, concomitantly pedicled on the superficial inferior epigastric vessels was elevated. A 2.5x4cm sired auricular cartilage carried in the shape of a human auricle was tacked on the inner surface of the flap, and the flap was tubed with 4-0 nylon sutures. The abdominal donor wound was primarily closed. At 17 days after elevation, the tubed abdominal flap was trimmed into a human ear shaped composite island flap connected only by the superficial epigastric vascular bundles, and the caudal pole was sutured back to the abdominal skin. Skin surface fluorometry was performed to assess the degree of skin perfusion. The percentage of skin flap survival was recorded 14 days later. The mean Dye Fluorescence Index was 68 14% of normal. Almost 100% of the skin was survived in all rabbits. The histologic study revealed infiltration of homogeneous granulation tissue between the cartilage and flap. The grafted cartilage was healthy and showed normal appearance. Using this principal of ear prefabrication through delay and revascularization of various tissues as an island composite flap, it can be applied in humans with scaring of the temporo-parietal region.