Query: Helical rim

title: Helical rim advancement A technique to avoid keloid recurrence
abstract: Helical rim keloids occur commonly following ear piercings, trauma and previous surgeries and can be disfiguring. Many techniques have been developed to treated these disfiguring lesions with varying successes, however, individuals prone to developing keloids inadvertently recur despite best efforts.  To determine whether helical rim advancement flap reconstruction following helical rim keloid excision can reduce recurrences.  Case series followed up to 2 years.   All patients who consented to helical rim advancement reconstruction after keloid excision.  The authors report a series of 7 patients with helical rim keloids ranging from 1.2 cm to 5 cm in widest diameter treated with keloid excision and reconstruction with helical rim advancement flap technique. There were no recurrences within a mean of about 19 months post operatively. Most patients report satisfaction with the cosmetic end result.  From the authors' experience, helical rim advancement reconstruction following excision of keloids about 2.5 cm in widest diameter is an excellent tension free option to avoid recurrence of helical rim keloids. Wound tension is a key risk factor for keloid formation. We hypothesise that the reason why there was no recurrence is because in helical rim advancement flap reconstruction, the underlying helical rim takes all the tension of closure off the dermis, resulting in tension free skin closure.  Helical rim advancement flap reconstruction is a viable technique to avoid recurrence and minimise cosmetic deformities of the pinna for selected helical rim keloids.

title: Helical Rim Reconstruction With Chondrocutaneous Hatchet Flap Z Plasty
abstract: Helical rim reconstruction is relatively difficult because of the unique anatomical structure of the ear. The aesthetic and functional characteristics of the ear make such reconstruction even more important. This article presents the newly defined chondrocutaneous hatchet flap Z plasty (HFZP) method in helical rim defects and evaluates the results.  This study retrospectively evaluates 14 patients who were operated on using the chondrocutaneous HFZP method after a tumor excision located on the helical rim. The etiologies of the patients were basal cell carcinoma (n 7) squamous cell carcinoma (n 2) and actinic keratosis (n 5) All patients were operated on under local anesthesia. The patients were evaluated regarding age, sex, etiology, defect location, and aesthetic outcomes.  Five patients were female, and 9 were male. The mean age of the patients was 72.2 years. Nine tumors were localized in the upper one third of the helical rim, and 5 were localized in the middle one third. The average duration of operation was 24 minutes. The aesthetic results were 11 patients (78.59% who recovered with excellent outcome, 2 patients (14.2% with good outcome, and 1 patient(7.1% with poor outcome. There were no postoperative complications, such as flap necrosis, infection, suture detachment hemorrhage, or hematoma.  The chondrocutaneous HFZP method is a simple, single stage method that uses local tissues without color mismatch. In addition to the method's geometric gain, there is no removal of healthy skin or cartilage, resulting in minimal decreases in the vertical and horizontal diameters of the ear.

title: Chondrocutaneous Bilateral Advancement Flap with Postoperative Radiation Therapy for a Helical Rim Keloid
abstract: Keloids can be recalcitrant, and a well planned treatment strategy is essential. Multiple ear piercings have recently become popular, particularly among younger age groups. Management of keloids that develop after piercing of the ear cartilage may be particularly problematic. Helical rim keloids are difficult to excise because of the complex, three dimensional, cartilaginous structure of the helix and its thin and tightly adherent covering layer of skin. The chondrocutaneous advancement flap introduced by Antia and Buch may be a useful reconstructive option for a helical rim keloid after marginal loss of a segment of the helix as a result of trauma, a burn, or excision of a malignant tumor. However, this technique is limited to wounds that involve only the helix. In this technical note, we describe the use of a chondrocutaneous bilateral advancement flap with postoperative radiation therapy to treat a more invasive and relatively large keloid on the scapha. This technique is straightforward and safe in terms of preserving the blood supply. The addition of adjuvant radiation therapy can help to decrease the risk of recurrence and preserve the morphological structure of the ear and patient satisfaction.

title: Helical Rim Advancement Flap with an Additional Postauricular Skin Flap: A Case Report
abstract: The auricle is a three dimensional cartilaginous frame covered with thin overlying skin. Due to its complex features, reconstructing helical rim defects after the excision of an auricular mass is challenging. Shortage of subcutaneous tissue and the presence of a tightly bound epithelium further hamper the primary closure of lateral (anterior) auricular skin defects. We present herein a case in which we used a helical rim advancement flap along with an additional postauricular skin flap. We achieved a satisfactory esthetic result with minimal loss of helical diameter and a low risk of flap necrosis by preserving the vascular network of the flap. This technique is less traumatic and will facilitate faster healing as well as improved patient recovery.

title: Split ear helix advancement flap for lesions of the ear involving the helical rim and adjacent skin
abstract: Reconstruction of helical rim defects after tumor removal poses a special challenge for the dermatologic surgeon due to the three dimensional structure of the ear with prominent character and aesthetic implications 1 Traditionally, tumors affecting the helical rim are removed by a wedge resection. This frequently leads to excisions that extend into the concave concha, affecting architectural integrity and scar contraction. Potential deformities of the wedge closure include webbing, where the elastic memory of cartilage causes it to pull apart, a "butterfl y appearance" with pinching of the helix into a bilobed structure, and cupping as the pinna moves anteriorly into a more prominent position than the contralateral ear 2 Other closure options involve split thickness skin grafting, but this is time consuming and leads to a secondary defect with a longer healing time than the primary site 3 The classic helical rim advancement fl aps overcome these complications and various modifi cations are described in the literature. However, they are not suitable if the perihelical skin is involved 4 8

title: Single Sling Island Pedicle Flap With Bilevel Undermining for Repair of Superior Helical Rim Defects.
abstract: Wounds of the helical rim are commonly encountered in Mohs surgery and canbe a challenge to reconstruct. This is particularly true if there is cartilage missing or the cartilage has been stripped of perichondrium making for a suboptimal base for skin grafting or second intention healing. Other commonly used reconstructive options include wedge resections, helical rim advancement flaps, hatchet flaps, bilobed flaps, banner transposition flaps, staged postauricular interpolation flaps, or a combination thereof. Despite the wide variety of options available,manyprove tobe less than ideal due to disadvantages including risk of ear asymmetry and morbidity to the patient due to the relative size of the repair in comparison to the size of the defect.

title: S10B 01 SESSION 10B
abstract: A retrospective chart review of the last 57 consecutive patients with helical rim deformities treated with InfantEar Non surgical Ear Molding System. Patient demographics included age, sex, duration of therapy and number of treatment options. Amazon Mechanical Turk (MTurk) was used to survey blinded respondents using photographs of patients' ears to determine the degree of normalcy for each ear on a scale of 1 (not normal) to 10 (completely normal) before versus after molding. The ear before and after molding was compared using a paired ttest and percent improvement.

title: Single stage helical rim reconstruction using a post auricular bipedicled flap
abstract: Middle third helical rim defects may arise from trauma or oncological resection, and pose a challenging reconstructive problem. Reconstructing defects larger than 2 cm using traditional methods commits patients to the inconvenience of staged procedures.  This paper describes a single stage helical rim reconstruction technique using a post auricular bipedicled flap and ipsilateral conchal cartilage graft for delayed middle third helical rim reconstruction.  Two examples of this technique used in post trauma and oncological reconstruction cases are presented, with pre and post operative photographs provided for demonstration.  Contralateral graft harvest and staged operations for helical rim reconstruction are associated with donor site morbidity and the inconvenience of multiple operations to achieve the desired reconstructive outcome. Our single stage helical rim reconstruction technique was well tolerated by patients, and showed satisfactory aesthetic results in terms of size and symmetry.

title: Successful replantation of an amputated helical rim with microvascular anastomosis
abstract: Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37 year old man had his helical rim amputated by a human bite. The amputee was about 4 x 1 cm in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.

title: Modified Chondrocutaneous Helical Rim AdvancementFlap: Reconstruction of
abstract: Due to its unique structure, repair of marginal pinna defects requires special considerations. Various repair techniques have been documented in the literature for decades but many of these techniques result in deformity of the pinna and some can be unnecessarily complicated. Here we report a novel technique for repairing such defects, which is actually a modification of an older method. We have shown that a natural auricle shape is achieved with minimal disruption of the anatomical landmarks.  Schematic representation of six Hillocks of Hiss and related structures.  Study Defects of the helical rim may occur as a result of trauma, burns or cancers. The helical rim of the ear is involved in 45 55% of cancers of the ear  The helical rim is a common site for basal cell and squamous cell carcinoma as this is a sun exposed area. It is also an area which can be susceptible to trauma resulting in marginal loss. Reconstruction of auricular defects with 'like for like' (ideally pinna) tissue offers the best aesthetic option. There is, however, a paucity of redundant local ear tissue, owing to well defined landmarks of the semi rigid cartilage and tight adherence of the overlying skin. A total of one hundred patients underwent repair of a pinna defect between 2004 and 2008 at our institution. The inclusion and exclusion criteria are listed below