Archives of Plastic Surgery (May 2013)
The Importance of a Conchal Bowl Element in the Fabrication of a Three-Dimensional Framework in Total Auricular Reconstruction
Abstract
Background To construct a sophisticated three-dimensionalframework, numerousmodifications have been reported in the literature. However, mostsurgeons have paid little attentionto the anatomical configuration of the concha and more to its deepness and hollowness,leading to unsatisfactory outcomes.Methods For a configuration ofthe concha thatis definitely anatomical,the authorfurtherdeveloped and employed the conchal bowl element,which has been used by severalsurgeonsalthough the results have not been published elsewhere. The author constructed the conchalbowl element in one of three patterns according to the amount of available cartilages: oneblock,two-pieces, or a cymba bowl element only. A total of 20 patients underwent auricularreconstruction using a costal cartilage framework between 2009 and 2012. The 8 earliestreconstructionswere performedwithout a conchal bowl element and the latter 12with a conchalbowl element. The patientswere followed up for more than 1 year. The aesthetic resultswerescored by evaluating characteristicsinvolving the stability ofthe crus helicis,the conchal definition, and the smoothness ofthe helical curve.Results The earsreconstructed earlywithout a conchal bowl elementshowed a shallowandone or two incompletely separated concha with an obliterated cymba conchal space. Theyalso did not have a realistic orsmooth curve ofthe helix because of an unstable crus helicis.However, earsreconstructed laterwith the concha bowl elementshowed a definite crus helicis,deep cymba conchalspace, and smooth helical curve.Conclusions The construction of the conchal bowl element is simple, not time-consumingprocedure. It is suggested that the conchal bowl element must be constructed and attachedto themain framework for natural configuration ofthe reconstructed ear.
