RU2419404C1 - Method of external auditiry meatus - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, namely to ENT-surgery, and can be applied in operations for tumours of skin, soft tissues of auricle and external auditory meatus. Essence of method lies in the following: after dissection of skin of external auditory meatus, in parotid area of the same side cut is transposition leaf skin-fat flap, whose pedicle is located at the level of fixation of lower edge of auricle (behind ear lobe) and contains feeding axial vessel - posterior ear artery. After mobilisation flap is transferred onto anterior surface of auricle, for which purpose created is through cut of auricle in area of its lower edge. Cut length corresponds to width of flat feeding pedicle. Flap is placed on defect of external auditory meatus and sewn. Wound in paroid area is sewn with simple approaching wound edges, with preservation of feeding flap pedicle. In lumen of auditory meatus silicon tube up to 2 cm long, whose external end is fixed with suture to hircus skin, is placed. As the second stage of operation, after a week, dissection of skin of flap feeding pedicle is carried out with sewing of its distal part to skin of anterior surface of auricle, and of proximal part - to skin of posterior surface of auricle. Silicon tube is removed from auditiry meatus 3 weeks after operation. ^ EFFECT: application of claimed invention makes it possible to ensure complete flap engraftment, as well as to achieve steady functional and esthetic result. ^ 1 ex, 3 dwg

Description

The invention relates to medicine, mainly to operations for tumors of the skin and soft tissues of the auricle and external auditory meatus.

After excision of the neoplasms of the skin of the external auditory canal, suturing of the wound with local tissues is impossible, since the skin in this area is thin and tightly fused with the underlying cartilage. As a result, there is a need for plastic replacement of the resulting defect.

A known technique described by Petres J. et al. in 1996 (Petres J., Rompel R., Robins P. Dermatologic Surgery. - Springer, 1996, P.354, Fig.337a-d, analogue), based on the use of a free full-layer transplant from the behind the ear for reconstruction of the external auditory meatus defect area. With this technique, a full-layer skin graft is cut out in the behind-the-ear region, placed on the defect and sutured. The disadvantage of this technique is that a free skin graft is often prone to necrosis due to malnutrition, since the skin graft is placed on the cartilage tissue, which is poorly supplied with blood.

The closest in technical essence is the technique described by Petres J. et al. in 1996 (Petres J., Rompel R., Robins P. Dermatologic Surgery. - Springer, 1996, P.350, Fig.333, af, analogue), consisting in the reconstruction of the external auditory canal defect with a transpositional skin-fat rag from the parotid area. The technique is as follows. After excision of the tumor of the external auditory canal in the parotid region an anterior skin-fat flap is cut anterior to the tragus, its distal part fits into the defect and sutured. The second stage of the operation is the cutting off of the feeding leg of the flap. This method has the following disadvantages: the flap does not include a feeding axial vessel, which can cause trophic disorders or necrosis; after excision of the flap in the parotid region, a scar remains on the open part of the face, which causes an aesthetic defect; the technique does not provide for the formation of a lumen of the external auditory canal, as a result of which cicatricial atresia of the latter may occur.

The objective of the invention is to improve the functional and aesthetic results of the surgical treatment of neoplasms of the skin and soft tissues of the external auditory canal.

The method is as follows.

Under endotracheal anesthesia after excision of a skin tumor of the external auditory canal (Figure 1), a transpositional petal skin-fat flap is cut out in the behind-the-ear area of the same name, the leg of which is located at the level of attachment of the lower edge of the auricle (behind the lobe) and contains a feeding axial vessel - back ear artery. After mobilization, the flap is transferred to the front surface of the auricle, for which a through cut of the auricle is created in the region of its lower edge, the length of the cut corresponds to the width of the feeding leg of the flap. The latter fits into the defect of the external auditory meatus and is hemmed. The wound in the behind-the-ear area is sutured with a simple approach of the wound edges while maintaining the feeding leg of the flap. In order to form a lumen of the external auditory canal and prevent cicatricial narrowing, a silicone tube with a diameter of about 1 cm, a length of 2 cm, is placed in its lumen, the outer end of the tube is fixed with a suture to the skin of the tragus (Figure 2). The second stage of the operation, a week later, under local anesthesia, the skin of the feeding flap is dissected with the distal part sutured to the skin of the anterior surface of the auricle, and the proximal to the skin of the posterior surface of the auricle. This eliminates the through defect of the auricle. The silicone tube is removed from the ear canal 3 weeks after surgery. This method showed complete engraftment of the flap, a good functional and aesthetic result (Figure 3). Advantages of this technique: the flap has an axial feeding vessel (posterior auricular artery), due to which successful engraftment of the flap and primary wound healing are achieved; the flap is taken in the behind-the-ear area, as a result, the postoperative scar remains invisible and the aesthetic effect of the operation is not disturbed; thanks to the use of a silicone tube placed in the external auditory canal after surgery, its cicatricial narrowing and, as a result, hearing loss in the patient are prevented.

Figure 1. Illustrates the type of patient before surgery.

Figure 2. Demonstrates a hemmed flap and view of a silicone tube in the external auditory canal.

Figure 3. Illustrates the view of the patient 3 weeks after surgery.

An example implementation of the claimed method

As an example, we cite the following observation:

Patient S., 71 years old, was admitted to the Yaroslavl Oncology Center for Surgery "Head-Neck" 11/25/08 complaining of a tumor on the skin of the external auditory canal on the right. From the anamnesis: in August 2008, for the first time I felt pain in the area of the external auditory canal on the right. In October 2008, he turned to an oncologist, a scraping was taken from a tumor of the skin of the ear canal, cytology No. 8799 of 10/25/08: basal cell carcinoma. On examination, a tumor in the form of an ulcer, with a diameter of up to 2 cm, is located on the posterior and lower walls of the initial section of the external auditory canal on the right. Clinical diagnosis: basal cell carcinoma of the skin of the external auditory canal on the right T2N0M0, I st. The patient performed an operation on 11.27.08: excision of the basal cell skin of the external auditory canal on the right with plastic transposition of a skin-fat flap based on the posterior ear artery. Under endotracheal anesthesia, a skin tumor of the external auditory meatus was excised on the right, departing from the edges of 3 mm. In the behind-the-ear region, a transpositional petal skin-fat flap on a leg up to 1.5 cm wide containing the posterior ear artery is cut to the right. A through incision was made in the auricle up to 1.5 cm long in the region of its lower edge, a flap was made through an incision on the front surface of the auricle, placed on a defect in the external auditory meatus, and hemmed with Proline 4-0. The wound in the behind the ear region is sutured by a simple approach of the wound edges. In order to form the lumen of the external auditory canal, a silicone tube up to 2 cm long is placed in its lumen, the outer end of the tube is fixed with a suture to the skin of the tragus. A week later, the second stage of the operation was performed: under local anesthesia, the skin of the feeding leg of the flap was dissected with suturing of its distal part to the skin of the anterior surface of the auricle, and the proximal part to the skin of its posterior surface, the through defect of the auricle was eliminated. The wound healed by primary intention. Sutures were removed after 10 days. Silicone tube removed from the ear canal after 3 weeks. The flap is viable, the cosmetic effect is satisfactory. Histology after surgery No. 45033-36 of 03/03/08: solid basal cell carcinoma. After surgery, the patient is monitored for a year. There was no evidence of tumor recurrence.

Claims (1)

Method for plastic surgery of an external auditory meatus defect using a behind-the-ear transpositional skin-fat flap based on the posterior ear artery, characterized in that the flap is formed in the behind-the-ear area of the corresponding side, transferred to the front surface of the auricle through the through incision in the region of its lower edge, fits into the defect of the external auditory meatus and is hemmed, a silicone tube up to 2 cm long is placed in the auditory meatus, the external end of which is fixed with a suture to the skin of the tragus, after a week the second stage operation performs dissection skin pedicled flap to suturing of the distal portion of its front surface to the skin of the pinna and proximal - the back surface of the skin of the shell, silicone tubing is removed from the auditory canal after 3 weeks after surgery.

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