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 following cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion. Patients and methods: One hundred consecutive patients with prominent ears were operated between January 2018 and February 2023 using a de-epithelialized postauricular dermofascial flap that is performed as an adjunct to our 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 (IQR 9-15) years. One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur, compared to our earlier study of cartilage-sparing technique without the postauricular flap in which 17 out of 200 patients had suture extrusion (p=0.001). No hematoma occurred that necessitated return to the theatre. Skin necrosis and wound dehiscence did not occur in any case. No patients 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 to cartilage-sparing otoplasty alone. We recommend using this flap for both primary and revisional otoplasty.