BIOMECHANICS OF THE HELICAL RIM ADVANCEMENT FLAP

Objectives: To determine how helical rim closure with advancement flap s affects ear length and cupping, to compare the tension of closure wi th wedge excision and helical rim advancement and the effects of 3 ten sion-decreasing surgical techniques, and to review clinical experience with this flap. Design: The laboratory study was performed on 6 fresh cadaver ears, by means of sequential excision of tissue, and closure tension was measured with a strain gauge. Results obtained in 10 patie nts were reviewed. Setting: University referral hospital. Patients: Te n patients with helical rim defects treated with helical rim advanceme nt flaps. Intervention: In cadaver ears, a helical rim defect of 5 mm was enlarged sequentially to 10 mm, 15 mm, and finally 20 mm. In the p atients, defects of the helical rim caused by trauma or tumor were clo sed by this helical rim advancement flap method. Main Outcome Measures : For the laboratory study, the outcome measures were tension of closu re of the defect, ear length, and ear cupping. For the review of cases , outcome was determination of perioperative complications and the pat ient's and surgeon's judgment of cosmetic appearance. Results: Closure of a helical rim defect with advancement flaps caused minor shortenin g and moderate cupping of the ear. The tension of closure was decrease d by extending the inferior incision into the earlobe, creating a Buro w triangle, and shaving cartilage from the scapha. Both the Burow tria ngle and the scaphal shave caused mild increases in ear cupping. Concl usion: Helical rim advancement flaps provide satisfactory closure of h elical rim defects up to at least 20 mm (longer in some ears) with exc ellent preservation of normal anatomic landmarks and a near-normal app earance of the reconstructed ear.