Bahan Modul 3
Bahan Modul 3
Bahan Modul 3
in our department during 2005. The first patient Both patients had full-thickness tragal defect ex-
was a 66-year-old woman with a history of tending to the pretragal area (Figure 1). How would
diabetes and the second patient was an you manage this wound?
All authors are affiliated with the Department of Plastic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva
and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
& 2007 by the American Society for Dermatologic Surgery, Inc. Published by Blackwell Publishing
ISSN: 1076-0512 Dermatol Surg 2007;33:723–726 DOI: 10.1111/j.1524-4725.2007.33150.x
723
TRAGUS RECONSTRUCTION AFTER TUMOR EXCISION
The tragus and pretragal depression are one of the In our patients the tragus was reconstructed in a
many fine components of the normal ear. The tragus single-stage procedure with preauricular flap. The
holds aesthetic importance, as its distortion or flap can be superiorly based, as in our cases, or
absence creates an unnatural appearance of con- inferiorly based. It is designed as a transposition flap.
tinuity of the cheek and ear. It also serves a minor The medial limb should begin at the upper aspect of
functional role as a protective hooding for the the defect and extend along it. The lateral limb
external meatus.1 should begin at the same height and finish hidden in
the preauricular wrinkle (Figure 2). The distance
The aesthetic importance of the tragus presents between the medial and lateral limbs of the flap (flap
itself especially in two situations in plastic width) should be about the length of the defect
and reconstructive surgery: (1) tragus (Figure 2, a ¼ a), although a slightly narrower flap
reconstruction is part of ear reconstruction in should be as effective. It is important to make sure
microtia2–4 and (2) many techniques exist that the donor site can be closed without tension to
in rhytidectomy incisions to try to avoid tragus avoid an unacceptable scar. This can be checked by
distortion.1 using a pinch test. If there is tension, the adjacent
cheek should be undermined.
A less common presentation of the need to recon-
struct the tragus is after local tumor excision The flap length can be slightly less than the defect
such as basal cell carcinoma or squamous cell width plus double the width of the planned tragus.
carcinoma. Although many techniques of tragus The size of the reconstructed tragus can be deter-
reconstruction in microtia are described,2–4 there is mined by measuring the contralateral one (Figure 2,
only one report in the medical literature of such b ¼ b þ c 2).
724 D E R M AT O L O G I C S U R G E RY
ADLER ET AL
The flap is raised distally to proximally in the Aesthetically we noted good projection of the
subdermal layer. Its thickness should be greater near tragus, which was even better than that in
the base to include 2 to 3 mm of subcutaneous tissue the immediate postoperative period even without
to ensure adequate blood supply. Then the flap is cartilage graft for support. The reconstructed
rotated laterally (Figure 3) and folded onto itself tragus closely resembled the contralateral one
(Figure 4). Before folding of the flap, an absorbable (Figure 5). The scar at the donor site was
suture can be passed from the subcutaneous tissue in well hidden by the preauricle wrinkle. Both
the pretragus area to the flap lying above it, in order patients reported satisfaction with the
to create a pretragus depression. The distal end of results.
the flap is sutured to the edges of the external meatus
using 5–0 monocril. The donor site is closed primary
with 5–0 nylon.
Conundrum Keys
The preauricular flap is a random pattern
Tragus reconstruction techniques have four major
cutaneous flap based on the rich blood supply of
goals:
this area. Perfusion of the preauricular area
is mainly through the superficial temporal
vessels. 1. A pretragus depression without continuity of
the cheek and ear.
The postoperative course was unremarkable except
for some superficial (epidermal) skin sloughing in 2. Good tragus projection.
one patient which resolved with no treatment
3. Hidden external meatus.
within 1 week. At the 1-year follow-up there
were no wound complications in either patient. 4. Inconspicuous donor site scar.
726 D E R M AT O L O G I C S U R G E RY