Further Refinements in Otoplasty Surgery: A Modified Approach to Prevent Suture Extrusion in Cartilage-Suturing Otoplasty Using a Postauricular Dermofascial Flap

Background: Suture extrusion has been reported to be the most common complication after cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion. Methods: A total of 100 consecutive patients with prominent ears were operated on between January of 2018 and February of 2023 using a deepithelialized postauricular dermofascial flap that is performed as an adjunct to the authors’ cartilage-sparing otoplasty technique, which is essentially a combined modified Mustardé and Furnas technique. The flap is used to cover the cartilage-holding sutures with an extra layer of vascularized tissue to avoid the scar being directly over these sutures. Results: The median age of patients was 12 years (interquartile range, 9 to 15). One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur; in an earlier study of cartilage-sparing technique without the postauricular flap, 17 out of 200 patients had suture extrusion ( P = 0.001). No hematoma occurred that necessitated return to the theater. Skin necrosis and wound dehiscence did not occur in any case. No patient developed cartilage deformities or relapse requiring surgical correction. Conclusions: Combining cartilage-sparing otoplasty using sutures and the described postauricular dermofascial flap is simple to perform and has significantly reduced the complication rate and improved the outcome compared with cartilage-sparing otoplasty alone. This flap is recommended for both primary and revisional otoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.