Six tissue expansion sessions of the scalp for reconstruction of post-burn alopecia.

Postburn scalp alopecia has severe aesthetic and psychological implications. We describe herein a case of a 16-year-old girl suffering from postburn scalp alopecia consisting of approximately 70% of her scalp, with only some residual patches of hair in her left occipital and nuchal areas. The patient underwent six serial tissue expansions during a period of 8 years, thereby enabling coverage of a significant part of the scalp area, with advancement of the hair line laterally and anteriorly. The outcome of this case serves to reinforce the practice of multiple tissue expansion to the scalp, with minimal hair loss and some hair thinning, resulting in a satisfactory aesthetic outcome.

[Chest wall deformity following rib cartilage harvesting for auricular reconstruction].

Chest wall deformity is one of the potential complications of rib cartilage harvesting for auricular reconstruction. An eight year old boy underwent two stage microtia reconstruction using the 6th-9th costal cartilage for the 3-D cartilage framework. One year later an anterior chest wall deformity was noticed with bulging of the 5th rib, asymmetry of the lower rib cage line and deviation of the lower part of the sternum. The anterior chest wall is made of ribs, sternum and respiratory muscles forming a dynamic structure. By using these pieces of rib cartilage an imbalance is created in which the respiratory muscles pull the edges of the remaining ribs, thereby creating the deformity. It is especially critical during the growth phase. The 3-D CT scan demonstrates the chest deformity. We present a literature review and recommendations on how to reduce the complications when using rib cartilage for auricular reconstruction are presented.

[Our experience with two stage ear reconstruction of typical microtia].

One of the most difficult reconstructive procedures is the reconstruction of the auricle, since it has a very difficult form to imitate. During the last four decades there have been numerous reconstructive attempts throughout the world especially for cases of microtia. The principle is to build a framework from cartilage that will be used for the reconstruction. A prominent personality in this field is Dr. Burt Brent, who is identified with this challenge. Dr. Brent has established the method of reconstruction in four stages. In order to limit the operative stages Dr. S. Nagata suggested doing the reconstruction in two stages, using a different cartilage framework and elevating the auricle using temporo-parietal fascial flap and skin graft. His method was improved further by Dr. Francoise Firmin. The first stage is conducted at the age of 9-10, during which the ipsilateral rib cartilage is harvested, carved and put together into a cartilage framework and than inserted into a skin pocket in the area awaiting reconstruction. Half a year later, the auricle is elevated by inserting a wedge cartilage behind it, covering with temporo-parietal fascial flap and skin graft. Our experience using this method in ten microtia cases proves that it is a good choice in total auricle reconstruction for microtia patients.